IBCLC Exam Prep Questions and Answers

IBCLC Exam Prep Questions and Answers What is the first question to consider when helping a breastfeeding mother with a medication question? A) What is the relative infant dose of the medication? B) What is the protein binding of the medication? C) What is the molecular weight of the medication? D) Is the medication really necessary to take now? D Which drug property results in more transfer of the drug into the mother's milk? A) Molecular weight 800 Daltons B) High protein binding C) High lipid solubility D) Low maternal plasma concentration C When it comes to medications and breastfeeding, drugs with a shorter half-life are preferred. How many half-lives until it is generally considered that the drug is eliminated from the system? A) 3 B) 5 C) 7 D) 9 B If a woman is given 80 mg of a drug to treat a urinary tract infection - and the drug has a half-life of 3 hours - how much will be left in her system after 3 half-lives? A) 40 mg B) 20 mg C) 10 mg D) 5 mg C What is considered a high enough molecular weight that the medication will be too big to easily get into the breast milk compartment? A) 200 Daltons B) 300 Daltons C) 400 Daltons D) More than 800 Daltons D Drugs can be highly bound to albumin, a large protein in the blood circulation, and therefore too big to get into the breast milk space. What percentage of protein binding is considered high and therefore preferred? A) 40% B) 60% C) 80% D) 90% D While most drugs are compatible with breastfeeding, a few are not. Which type of drug is usually contraindicated for breastfeeding? A) Antibiotic B) Antidepressant C) Chemotherapy D) Diabetic therapy C A Relative Infant Dose (RID) of _____ indicates compatibility with breastfeeding. A) 10% B) 10% A) 10% A good resource to use to figure out if a medicine is compatible with breastfeeding is: A) The Physician Desk Reference (PDR) B) The medicine package insert C) Google D) LactMed D) LactMed In Hale's Medications and Mothers' Milk, which lactation risk category is the safest? A) L1 B) L2 C) L4 D) L5 A In Hale's Medications and Mothers' Milk, what lactation risk category does a medication go into if there is absolutely no published data about the medication, even if it is considered safe? A) L2 B) L3 C) L4 D) L5 B In which lactation risk category in Medications and Mothers' Milk is this the recommendation: "The drug is contraindicated in women who are breastfeeding an infant." A) L2 B) L3 C) L4 D) L5 D) L5 Many antibiotics are safe for the breastfeeding mother to take. However, caution needs to be taken with this antibiotic, ________, about which Hale's Medications and Mothers' Milk says, "This antibiotic can be extremely toxic, particularly in neonates, and should not be used for trivial infections." A) Ampicillin B) Chloramphenicol C) Gentamicin D) Metronidazole B) Chloramphenicol Plasma levels of most topical and ophthalmic preparations are virtually nil and are not likely to produce milk levels at all. A) True B) False A) True Some drug pumping systems exist in the alveolar cell (the cells that line the milk sac). For example, iodine is readily pumped into the milk compartment. Therefore, any form of radioactive iodine should be avoided while breastfeeding. A) True B) False A) True Although there are many exceptions, in general, _______ of the maternal dose finds its way into the milk and, subsequently, to the baby. ***(Do not confuse this with Relative Infant Dose) A) 1% B) 5% C) 10% D) 12.5% A What is the AVERAGE volume of milk consumed per 24 hours by a breastfed baby around age 2-4 weeks? A) 550-600ml (18-20oz) B) 650-700ml (21.5-23oz) C) 750-800 ml (25-26.5oz) D) 850-900ml (28-30oz) C Which statement about the effect of human milk on the child's immune system would be MOST important to medical students? A)Human milk stimulates the baby to begin making his own SIgA and other antibodies. B)Exclusively breastfed babies have a poorer response to immunizations. C) The mother's own milk provides passive immunity between placentally acquired immunity and autonomous immune protection. D)The breastfed baby is at higher risk of infection because he relies on the mother's immune protection during breastfeeding C Which component of preterm milk is proportionally higher than in term milk? A) Protein B)Lactose C)Phosphorus D)Iron A Which is the MOST APPROPRIATE suggestion for a pregnant woman concerned about eating well enough for her own body growth and her developing baby? A)Take prenatal vitamins every day B)Eat fruits, vegetables, and protein-rich food 5 times a day C)Plan your meals and snacks so you can eat every few hours D)Plan to gain 25-35 pounds by the end of your pregnancy D A 3-week-old exclusively breastfed baby with a strong family history of allergy has a severe reaction the first time he is fed with a cow's milk-based formula. The MOST LIKELY explanation for this is that the: A)baby was sensitized by intact cow's milk proteins that passed into the mother's milk B)baby was given a bottle of formula in the hospital nursery C)mother consumed large amounts of dairy products during pregnancy D)allergic reaction was more likely due to the latex in the bottle nipple than the cow's milk C Which of the following components of human milk has the MOST immunological importance? A)Interferon B)Fibronectin C)Lactoferrin D)Secretory IgA D Which of the following protective components of milk is destroyed by freezing? A)Lysozyme B)Lymphocytes C)Secretory IgA D)Lactoferrin B According to studies of breastfed babies in an industrialized society, which of the following feeding patterns most closely approximates that of an exclusively breastfed 3-month-old baby? A)4-6 feeds per day, total 60 minutes or more B)6-8 feeds per day, total 100 minutes or more C)8-10 feeds per day, total 120 minutes or more D)10-12 feeds per day, total 140 minutes or more D (8-12 feeds 140-160 minutes) When are fat levels in mother's milk highest? A)When the milk ejection reflex is strong B)During the night C)After the mother eats a high-fat diet D)When the breast is relatively empty D Which of the following is the MOST IMPORTANT function of lactoferrin? A)Bind and deactivate pathogens B)Nerve Myelinization C)Iron Transport D)Anti-inflammatory agent A (also transports iron and is anti-inflammatory) What is thought to be the PRIMARY function of Montgomery glands? A)Pigmented marker for visual targeting B)Lubricate the skin of the areola C)Secrete antibiotic substances D)Change elasticity of areola skin B Which hormone in the milk is MOST responsible for anti-inflammation activity? A)Prolactin B)Prostaglandins C)Oxytocin D)Relaxin B Which breast structure contains muscle fibers? A)Lactiferous sinuses B)Alvoli and ducts C)Montgomery tubercles D)Lactocytes B (contain smooth muscle fibers) Approximately how much milk does a baby age 1-3 days obtain at the breast? A)150ml/day (5oz/day) of colostrum B)The baby gets increasing amounts each day as milk volume increases C)The baby needs a supplement until day 5 when mother's supply is sufficient D)The baby gets 750ml/day (25oz/day) from day 2 onward B (baby may only get around 30mls or 1 oz per day in first couple of days but increases drastically) The tail of Spence is mammary glandular tissue that: A)is only present with supernumerary nipples B)does not produce milk C)extends into the axilla D)is not connected to the breast duct system C-extends into the axilla Which of the following BEST explains the ease with which human milk fat is digested by the infant? A)Unsaturated fats account for 57% of total lipids B)Lipases are present in the milk C)Lipids are encased in membranes (globules) D)Cholesterol is the predominant lipid in human milk B (FYI Triglycerides are predominant in human milk) Which of the following components has the MOST SIGNIFICANT role in tissue maturation of the infant? A)Epidermal growth factor B)Nerve growth factor C)Secretory IgA D)Lactoferrin A (Epidermal growth factor plays a role in gut maturation) When comparing the 2006 WHO Growth Standards to the previous "growth charts" used for many years, which statement BEST describes the growth of exclusively breastfed babies by the first 6 months? A)Breastfed babies gain more weight B)Breastfed babies are longer in length C)There is no difference in weight gain D)Breastfed babies are leaner per height D (BF babies initially gain more weight but are leaner by 6 months) What is the MOST important function of secretory IgA in mother's milk? A) Protects mucosal membranes B)Actively destroys bacteria C)Enhances inflammation D)Suppresses infant's immune system A (Sec IgA is a primary antibody on mucous membranes which is respiratory and GI infections begin) Which organization administers the certifying examination for candidates to obtain the IBCLC credential? a. World Health Organization (WHO) b. Academy of Breastfeeding Medicine c. International Lactation Consultant Association (ILCA) d. International Board of Lactation Consultant Examiners (IBLCE) D The only internationally certified healthcare provider with expertise in breastfeeding and lactation medicine is the: a. Certified Lactation Counselor (CLC) b. International Board-Certified Lactation Consultant (IBCLC) c. Certified Nurse Midwife (CNM) d. Physician Assistant (PA) B The International Board of Lactation Consultant Examiners (IBLCE): a. Only provides a test for IBCLCs b. Licenses IBCLCs to practice c. Provides the IBCLC exam and establishes standards in breastfeeding care C The International Board of Lactation Consultant Examiners (IBLCE) was founded to: a. Teach mothers about breastfeeding b. Protect the public by providing an internationally recognized level of knowledge of breastfeeding care c. Discourage the use of formula for newborns B The documents of the IBLCE apply in: a. The USA only b. The hospital setting only c. All countries and all settings C The Clinical Competencies of the IBCLC include: a. Providing evidence-based information on the impact of medications taken while breastfeeding b. Promoting the principles of the Baby-Friendly Hospital Initiative c. Both a and b C Taking the IBCLC exam requires: a. Lactation education only b. Lactation education and clinical experience c. Lactation clinical experience only B The IBLCE Code of Professional Conduct includes: a. Actions for the IBCLC who has engaged in substance abuse b. How the IBCLC should dress c. Where the IBCLC should practice A Briefly, what is due diligence? a. Declaring bankruptcy b. Taking reasonable care not to harm someone c. Making a mistake d. Doing something that is illegal B Briefly, what is misfeasance? a. Taking reasonable care not to harm someone. b. Making a mistake c. Doing something that is illegal d. Declaring bankruptcy B Andrea, an IBCLC, has been working with a mother and infant for several weeks. She saw the family 3 times, but billed the insurance company for 6 visits. This is an example of: a. Due diligence b. Misfeasance c. Malfeasance d. Tax evasion C In what year was the IBLCE established? a. 1975 b. 1980 c. 1985 d. 1990 C A voluntary international professional membership association consisting of mostly IBCLCs is: a. International Board of Lactation Consultant Examiners (IBLCE) b. International Board-Certified Lactation Consultant (IBCLC) c. International Lactation Consultant Association (ILCA) d. Academy of Breastfeeding Medicine (ABM) C Which scientific journal is published by the International Lactation Consultant Association? a. Breastfeeding Medicine b. Birth c. Midwifery Medicine d. Journal of Human Lactation D The IBCLC Scope of Practice document: a. Can be found on the IBLCE website b. Is 38 pages in length c. Can only be obtained by written request from IBLCE A The IBCLC Scope of Practice includes: a. Preserving client confidence b. Promoting breastfeeding c. both a and b C On the subject of social media for the IBCLC: a. IBLCE has nothing to say b. IBLCE has an Advisory Opinion c. IBLCE recommends IBCLCs do not use social media B Which milk component causes the stools of exclusively breastfed babies to have a mild, yeast-like odor? a. Glycopeptides b. Candida albicans c. Phospholipids d. Bifidus factor D Crying is MOST likely to be: a. distress at separation from mother b. an indication of pain c. infant's attempt to manipulate mother d. stressful to the baby's physiology D Manufacturers of formula milks (breast milk substitutes) have attempted to increase the protective properties in their products by adding which of the following nonprotein nitrogen compounds found in human milk? a. Polyamines b. Nucleic acids c. Nucleotides d. Creatinine C The MOST LIKELY result of a mother eating cantaloupe would be: a. her milk will contain more Vitamin A b. her milk supply will increase c. the baby's breath may smell like cantaloupe d. the baby will reject the cantaloupe-flavored milk C (mother's milk can have trace flavors present based on food choices) Which of the following statements BEST describes the difference in fat content of colostrum vs. mature milk? a. Colostrum has 4-5 g/100ml, while mature milk has 2-3g/100ml of fat b. Colostrum has 2-3g/100ml, while mature milk has 4-5g/100ml of fat c. Colostrum has roughly one-fourth the fat content of mature milk d. Colostrum has 10cc of fat, while mature milk has 20cc of fat B If a 4-year old girl had a chest tube placed in her ribs below and distal to her right nipple, what is the most significant effect this surgery might have on her ability to breastfeed? a. damage to the ductal structure b. damage to the blood vessels supplying the breast c. severed nerve pathways to the nipple d. cut blood vessels to the breast C (tube placement is close to location of 4th intercostal nerve) What is the MOST IMPORTANT function of viral fragments that appear in human milk? a. Often cause infant illness b. Act as a "vaccination" against disease c. Digested by the infant as food d. Can be killed by heat treatments B (triggers baby's immune response and does not appear to transmit disease) Some brands of artificial baby milk produced in the 1980s lacked which essential nutrient causing brain damage and learning disabilities in infants that were fed this milk exclusively? a. sodium b. chloride c. potassium d. calcium B A baby's tongue is pressing a mother's nipple against the baby's hard palate. Which cranial nerve is MOST responsible for this tongue movement? a. Spinal accessory b. Vagus c. Hypoglossal d. Trigeminal C (CN XII) -the other nerves listed are more involved in suck/swallow/breathe actions Which of the following BEST describes fetal nutrition? a. The umbilical cord delivers nutrients directly to the fetal gut b. The fetus swallows and digests amniotic fluid c. The fetus absorbs nutrients from the amniotic fluid through his skin d. The fetus has no digestive enzymes of his own until after 40 weeks B (amniotic fluid has protein and other nutrients) Which of the following milk component is MOST LIKELY to explain higher scores in cognitive development and vision for breastfed babies? a. Long-chain fatty acids b. Short-chain fatty acids c. Phospholipids d. Sterols A (Omega-3 fatty acids DHA and AA especially) 1-3 Month-old babies may: a. Breastfeed 6-8 times per 24 hours b. Sleep for 2-3 hours once a day c. Grasp their toes during nursing d. Recognize other adults and smile B What is the average normal heart rate of a full-term infant? a. 80-100 BPM b. 100-120 BPM c. 120-160 BPM d. 160-200 BPM C Which term refers to the most frequent number in a set of numbers? A) Mean B) Median C) Mode D) Range C Which term means 50% of the numbers fall below the number and 50% of the numbers fall above the number? A) Mean B) Median C) Mode D) Range B Which term refers to the average of a set of numbers? A) Mean B) Median C) Mode D) Range A What is the range of this set of numbers? 9, 5, 8, 2, 13, 29, 27 A) 9 B) 27 C) 29 D) 2 B (29-2) A qualitative study: A) Cannot be used if research subjects only speak English B) Allows for exploration of ideas and experiences in depth C) Deals with numbers and statistics D) Must have a statistically significant result B (qualitative has the letter "l" which is "lovely"--words and experiences are "Lovely") A Likert scale is an example of: A) Gender data B) Economic disparity data C) Nominal data D) Ordinal data D (ordinal=order) A meta-analysis: A) Is another word for protocol B) Is another word for policy C) Summarizes the literature on a topic D) Statistically combines the results from several studies as if they were all part of one big study D A Type 2 error is sometimes referred to as a false negative error. This is when a study concludes there is no difference even though there actually is a difference. What can lead to a Type 2 error? A) The sample size being too big B) The control group being too big C) The sample size being too small D) The control group being too small C Researchers in a hospital were trying to figure out how to improve their breastfeeding rates. They conducted a study in the Labor and Delivery suite where one group of birthing women held their babies skin-to-skin for 20 minutes immediately after birth and another group held their babies skin-to-skin for 60 minutes after birth. All mothers had vaginal births, all were taught skin-to-skin holding the same way, and all mothers and babies were stable. Length of time breastfeeding for the first two hours of birth prior to the mother leaving the L/D suite was studied. In this study the independent variable is: A) Length of time breastfeeding in the labor and delivery suite B) The number of vaginal versus cesarean births in the study C) Length of time of skin-to-skin holding D) Rates of hand expression C (independent is what is manipulated) What is the dependent variable in a study? It is what is being measured Which P-value is considered not statistically significant? A) P = .35 B) P = .05 C) P = .01 D) P = .001 A Which P-value means there is a 1% probability that the findings of the research occurred by chance? A) P = .35 B) P = .05 C) P = .01 D) P = .001 C What is it called when people behave differently because they know they are being watched? A) Ocular effect B) Binocular effect C) Union effect D) Hawthorne effect D For a continuous data set, what % of the data should fall within plus or minus two standard deviations? A) 50% B) 68% C) 95% D) 100% C Which type of study design offers the highest quality of evidence? A) Case report B) Cohort study C) Randomized controlled trial D) Systematic review and meta-analysis D Bias is defined as any tendency which prevents unprejudiced consideration of a question. A) True B) False A Which type of study design tries the best to eliminate bias in research? A) Case report B) Cohort study C) Case - control study D) Randomized controlled trial (especially if double blinded) D Which milk component of human milk is active against at least 40 tumors? A)Alpha-lactalbumin B)Beta-lactoglobulin C)Lactoferrin D)Gangliocides A (also known as HAMLET) About how many calories are utilized in making milk per day? 500 Which component of human milk affects stool composition and frequency in the baby? A. Whey:casein ratio B. Soluble proteins C. Lactose D. Lipids A (ratio changes from around 90:10 to around 60:40 from early postpartum to around 6 months of lactation-higher casein usually means more firm/less frequent stools) When are the growth factors most concentrated in human milk? A. 38 weeks gestation B. 2 days postpartum C. 2 months postpartum D. 7 months postpartum B (most concentrated in colostrum and early milk) When does object permanence emerge? 4-8 month old period In the first 3-14 days, babies typically consume how much of the available milk from mother? A. all of it B. 3/4 C. 2/3 D. 1/2 C Which of the following foods would provide many of the nutrients contained in dairy products? A. Rice B. Pears C. Carrots D. Corn tortillas soaked in lime D (high levels of calcium) At what point during gestation does the mammary ridge develop? A. 4-5 weeks B. 14-15 weeks C. 24-25 weeks D. 34-35 weeks A What effect does cholecystokinin have on the infant when released when they are suckling? A. Arousal B. Satiety C. Agitation D. Depression B (and relaxation) What process is primarily responsible for the increase in breast size (volume) during pregnancy? A. increase in fatty stores in the breasts B. Development of the duct system C. Growth of secretory epithelial cells D. Growing uterus triggers ribcage expansion C (Lactocytes) What is a mutually interdependent occurrence? two phenomena that arise together and are connected by cause and effect (example infant's gut closure happens around the time they are ready for solid foods) What is the most important function of lactose in human milk? A. Supplies 40% of the infant's energy needs B. Aids absorption of phosphorous and manganese C. Protects the GI tract from pathogens D. Supports CNS and cognitive development D Which of the following components of human milk protects the baby by binding nutrients needed by pathogens in the baby's gut? A. Lactoferrin B. Lysozyme C. Mucins D. Oligosaccharides A (binds to iron and starves pathogens of iron needed to proliferate) Which description of oral function of the baby during breastfeeding has emotional implications? A. Sense of taste and smell of milk B. Pressure of the breast against the oral tissues C. Tactile sensation of breast filling the infant's mouth D. Ability of infant to control shape of breast C (critical part of imprinting and emotional and psychological development) Which is the MOST IMPORTANT factor in how breastfeeding protects the infant against allergy? A. Preventing the baby from exposure to nonhuman proteins B. Slowing or preventing the absorption of allergens through the baby's gut C. Protecting the baby's gut from inflammation, which weakens the mucosal barrier D. Providing white cells in milk, which attack the allergens directly A (they are key trigger in allergic disease) Which nodes collect most of the lymph drainage from the lactating breast? Axillary nodes At what developmental age is self-feeding MOST LIKELY to begin? 6-7 months