CBC Certification Practice Test Questions and Answers

CBC Certification Practice Test Questions and Answers A healthcare provider wants to encourage pregnant women to choose breastfeeding. Which statement is MOST supportive of breastfeeding? What have you heard about breastfeeding? [open ended question designed to explore the mother's preconceived ideas about breastfeeding] You work in a cinic with a lactation consultant who advises mothers to "toughen up" their nipples by rubbing them with a rough washcloth during pregnancy. The FIRST thing you should do is: Bring in research evidence of the harmful nature of this practice and discuss it with her [first step provide clinical evidence supporting or refuting this practice and discuss] What can affect the healthcare professional's presentation about breastfeeding? Combination of experience, philosophy, and credentials affect our presentation about breastfeeding Standards of practice for breastfeeding counselors include what four areas? 1. Clinical Practice: focus on helping breastfeeding families define and achieve their breast breastfeeding goals best achieved through assessing, planning, implementing, and evaluating 2. Breastfeeding Education and Counseling: encourage participation by mothers and shared responsibilities for decision making inckluding providing education to families and other heathcare professionals & emotional support 3. Professional Responsibilities: maintain professional conduct, practice ethically, remain clinically competent and accountable, consider legal responsibilities 4. Legal Considerations: practice within the law, within nursing scope of practice, and with consideration for client's rights of privacy and with respect for matters of confidentiality According to AWHONN, what are some of the resposibilities of staff nurses working with breastfeeding women? support and implement BFHI, maintain current & evidence based knowledge, participate in research, relay consistent & supportive messages, be culturally and developmentally appropriate, advocate for integration of breastfeeding information into edcucation programs, and advocate for breastfeeding as a cultural norm by supporting legislation and education Which of the following activities is permissible under the terms of the World Health Organization's International Code of Marketing of Breast Milk Substitutes? Detailed information on product composition provided to health workers [code specifies information on artificial feeding provided to health workers should be scientific and accurate] Marketing Code no advertising of infant formula/teats, no free samples, no promotion in health care facilities, no company sales representative, no personal samples/gifts, no words or pictures idealizing artificial feeding, unsuitable products should not be promoted A cultural attitude that emphasizes the sexual nature of breasts is MOST LIKELY associated with: Harassment for breastfeeding in public Which organization was the first in the United States to provide mother to mother support? La Leche League (1956) - founded to offset detrimental effect of negative attitudes found in hospitals and general antipathy toward breastfeeding; provided mother to mother support as well as services for professionals; national library and toll free number for quick advice or referrals; meetings held regularly cover topics from getting started through weaning Baby Friendly Hospital Initiative launched in 1991 by WHO/UNICEF; designed to help hospitals overcome barriers imposed on women and their families throughout the world; "optimal standard of care and best evidence-based practice in maternity setting"; promotes, protects, & supports breastfeeding through the ten steps List the ten points of "The Ten Steps to Successful Breastfeeding for Hospitals" as outlined by UNICEF and WHO? 1. Have written breastfeeding policy that is routinely communicated to healthcare staff and parents (comply with international market code & establish ongoing monitoring) 2. Train all staff in skills necessary to implement policy 3. Inform all pregnant women about benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within an hour of birth (uninterrupted skin-to-skin) 5. Show mothers how to breastfeed and how to maintain lacatation even if separated from infant (& manage common difficulties) 6. Give newborn infants no food or drink other than breastmilk unless medically indicated 7. Practice "rooming-in" 8. Encourage breastfeeding on demand (support mothers to recognize and respond to infant cues) 9. Give no artificial soothers to breastfeeding infants (counsel mothers on use and risks) 10. Foster establishment of breastfeeding support groups and refer mothers to them on discharge List some reasons why formula feeding replaced breastfeeding. rigid beliefs about child rearing, changing status of women, sexualization of breasts, lack of support (healthcare professionals, family, & media), workplace, free formula, cultural beliefs Twenty-six year old Sarah is having her first baby in four weeks. She asks her health care provider if she will be able to breastfeed after having breast reduction with her nipple autotransplanted at an earlier age. The BEST response is: She should try and see what happens [no assumption should be made, she should be followed closely in first weeks postbirth because surgery can disrupt ducts and nerve pathways needed for adequate milk synthesis] Accessory nipple or breast tissue is LEAST LIKELY to be found in which of the following locations? Outer thigh [other areas may have extra mammmary and/or nipple tissue remnant of galactic band - near umbilicus, inguinal region, axilla] Which is the primary or main immunoglobulin found in human milk? IgA - protects entire GI system Which component of milk is MOST variable? Lipids and Fat-soluble vitamins [proportion of fat in milk increases as breast empties and slight variation in fatty acid profiles with maternal diet] [proteins, minerals, and lactose do not vary] Which component of human milk is destroyed by freezing? Macrophages [& other living cells including T and B lymphocytes] List the hormones that influence changes in lactating breast. estrogen, progesterone, prolaction, oxytocin, thyroid stimulating hormone Estrogen increase during pregnancy stimulates ductile system ot grow - levels drop at delivery and remain low for first several months of breastfeeding Progesterone increase during pregnancy to stimulate growht of alveoli and lobes while suppressing secretory activity; inhibiting influences is so powerful that lactation may be delayed if placental fragments are retained after birth Prolactin secreted by anterior pituitary necessary for complete growth; stimulates receptor sites for initiation of milk secretion located on alveolar cell surfaces; rise throughout pregnacy and sleep; plasma prolatin levels increase sharply following delivery of placenta; essential for initiating, maintaing, and secreting milk but not directly related to milk volume Oxytocin response to nursing posterior pituitary release causing letdown causing contraction of myoepithelial cells necessary for removal of milk; may feel pressure, fullness, tingling, or warmth during this ejection; can be inhibited by pain or stress or synthetic oxytocin Thyroid Hormone ( TSH) increase responsiveness of mammary cells to prolcatin and can improve lactation performance What event triggers Lactogenesis 2? Secretory Activation; placental expulsion leads to sharp decline in levels of lactogen, estrogen, and progesterone -- decline in progesterone initiate lactogenesis 2 which is onset of copious milk secretion as progesterone is prolactin inhibitor -- prolactin rises dramatically enabling full milk production 30-72 hours postpartum Lactogensis 3 (Galatopoiesis) maintenance of established lactation; stage of mature milk production and supply no later than 9 days after birth to involution; requires milk synthesis and release into alveoli; infant suckles at breast releases oxytocin & milk ejection reflex cause diameter of ductile to expand and milk travels through nipple opening into mouth; nipple has 5-10 pores Weaning/Involution when milk is not removed increased pressure lessens capillary blood flow and inhibits lactation process; complete on average approximately 40 days after complete cessation of breastfeeding Milk Production sufficient glandular tissue + intact nerve pathways and milk ducts + adequate hormones and functional hormone receptors + frequent and effective milk removal and breast stimulation = ample milk production (primary failure is first three); 4/5th week production of 25-35 oz per day Prolactin Receptor Theory first 10 days after delivery prolactin response to stimulation at peak - higher prolacting levels the more receptors activated increasing milk production; poor breast drainage leads to fewer receptors being activated and limited production Breast Fullness & Milk Production -full breasts make milk slower (feedback inhibitor of laction - more milk more peptide/whey protein that slow milk production); internal pressure reduces blood flow and compresses milk making cells -drained breasts make milk faster -storage capacity can vary greatly - cue feeding important -intercept time - point at which breast fullness causes milk production to slow Delayed Milk After Birth hormononal issues (birth issues, overweight, health conditions, medications), underdeveloped breasts, breast surgery, unusual nipple anatomy, timed feedings, shallow latch, newborn healht issues, separation of couplet Contraindications to Breastfeeding HIV, galactosemia, HLTV, brucellosis, active tuberculosis, active herpes lesions on breast What are some considerations when assessing the nipple? nipple types (common, flat/short, pseudo-inverted, retracted, inverted) -Flat: protractility cannot be visible seen -Inverted: true when remain when compressed or stimulated -Pseudo: appears inverted but everts when compressed -Short-Shanked: appears everted but retracts when compressed Tail of Spence mammary glandular tissue extends into axillary region - connects to duct system and potential area of milk pooling and mastitis Accesory Breast and Nipple Tissue/Hypermastia can be anywhere along mammary ridge - from axilla to groin and labia; can lactate and undergo malignant changes Hypoplasia underdevelopment of breast/insufficient glandular tissue; usually do not experience breast changes during pregnancy; present increased risk for insufficient milk Breast Augmentation implants seldom interrupt supply but periareolar incisions can damage supply; large implants can compress ducts and impede supply; hyaluronic acid injections are not a contraindication What are some assessment considerations when a women has had a breast reduction? full breastfeeding may not be possible depending on technique, tissue removed, and integrity of blood supply and nerve pathways; pedicle technique most successful, free nipple technique more damage occurs, liposuction just removes fatty tissue; infants should be closely monitored and supplementation might be needed Pierced Nipples jewelry should be removed; leaking milk from piercing holes, mastitis, reduced or extra sensitivy of nipple Assess Nipple and Breast identify anatomic issues including scarring or previous breast trauma, breast surgery, nipple piercing, flat/inverted nipples, lack of breast changes; provide education and follow up Name the major components of breast milk. dynamic liquid tissue that includes both cellular and nutritional components (colostrum - transitional - mature); each stage desiged to meet individual nutritional and immunological needs; made up of fats, proteins, carboydrates, vitamins, minerals, and over 88% of water Fats in BM made up of triglycerides, vehicle for fat-soluble vitamins, essential for cell membrane & brain development, precursor of prostaglandin and hormones, most variable & higher in mature milk and in afternoon, evening, and hindmilk, affected by maternal diet, gestation, and parity Proteins in BM -Casein: curd, high ratio allows for iron to be absorbed, main nutritional mechanism for delivering calcium and phosphorus Whey: lactalbumins, majority of human milk proteins, lactoferrin higher in colostrum, secretory immunoglobin A protect against respiratory and enteric bacteria and virs, lysozyme destroys enterobacteriaceae and gram-positive bacteria - concentration increases as lactation progresses Carbohydrates in BM lactose is main, constant and stable and 40% of calories and energy needs - protects GI tract, supports CNS and cognitive development; regulates volume of milk; creates acidic environment in gut decreasing bacteria and increasing elements absorption; others include oligosaccharides and glycoconjugates which play role in growth and immune function Vitamins in BM fat soluble A, D, E, K present but decrease over lactation; beta-carotene (precursor to A) makes colostrum yellow; water soluable C, thiamin, riboflavin, niacin, B, biotin, and acid increase over laction; influenced by maternal content; zinc and vitamin K is lowest in colostrm and increases Minerals in BM diet has little effect; contains calcium, phosphorus, magnesium; regulate body function; related to infant sucking, poor suckling increase Lactoferrin properites are for iron transport and as anti-inflammatory agent by binding iron needed by pathogens in gut Secretory IgA binds microbes in gut, anti-inflammatory, stimulate immune system; high in colostrum; paint intestines with protective coating to prevent penetration of allergens (takes two weeks for gut to recover normal flora after one bottle formula) Bifidus Factor supports gut colonication with lactobacillus bifidus, protects gut mucosa from pathogens - stools have yeast-like odor; immunological signifant soluble components include interferon, fibronectin, and lactoferrin Newborn to Day 5 Intake days 1-3 about 30 ml/day of colostrum and up to 600 ml/day or more by day 5 Lysozyme destroys E coli and other bacteria, increases in milk after 6 months of laction, and is active against inflammation and is stable during pasteurization Formula Contents does not contain secretory IgA, lysozyme, macrophages, enzymes, growth factors, and hormones such as CCK, melatonin, leptin, and cortisol Rusty Pipe Syndrome brownish color in breastmilk that occurs most often at onset of lactation and dissipates over time; coloration due to small amounts of blood from broken capillaries in breast What are three ways stimulate the milk ejection reflex? *when infant sucks effectively, stimulates nerve endings - signal to pituitary by way of hypothalamus - initiates secretion of prolactin and oxytocin - milk squeezed from alveoli into ducts and out the nipple (several throughout feeding) 1. Infant Suckling 2. Manual Expression or Pumping 3. Emotional Responses Preterm Milk higher in protein, sodium, chloride, and immune factors List three signs that let-down has occurred. tingling in breasts, feeling of warmth/fullness in breast, dripping milk before nursing, release of milk from nipple not being suckled, uterine contractions, relief of nipple of breast discomfort Types of Breast Milk Colostrum: first week; thick & yellow; increased proteins, minerals, lactoferrin, & immunoglobulins but decreased fat and lactose; facilitates meconium Transitional: develops 7-10 days until 2 weeks; bowel movements change as concentration of protein, fat-soluble vitamins, and immunoglobins increase while lactose, fat, and caloric content increases Mature: higher water and lipid concentration What is the largest component of breastmilk? water Montgomery's Tubercles located around areola: secrete substance that lubricates & protects nipple and may produce scent to help infant lacte nipple Alveoli secretory cells in which milk are produced Lactocytes speciliazed epithelial cells that line interior of alveolus and absorb nutrients, immunoglobulins, and hormones from mother's blood stream Prolactin Receptor Sites in the lactocytes that allow prolactin to be absorbed from the blood and enter into the alveoli to stimulate milk production Myoepithelial Cells encase the alveoli and contracts in response to oxytocin to eject milk into ductules Stroma supporting tissue of the breast such as connective tissue, adipose tissue, blood vessels, nerves, and lymphatics Cooper's Ligament suspensory ligaments running vertically through the breast that attaches the deep layer of subcutaneous tissue to the dermis layer of the skin Embyrogenesis mammary gland begins to develop as 5 week old embryo and distinct mammary glands are present and palpable at birth Mammogenesis breast maturation; onset of puberty with influence of estrogen and progesterone; estrogen influences growth of primary and secondary ducts and formation of club-shaped end buds; both hormones produce changes in breasts every month with each menstrual cycle the ends bud develop into new branches and small ductules of areolar buds which will become acini or alveoli Lactogenesis Stage 1 Secretory Differentiation (Pregnancy) - breast does not reach full function until pregnancy and child birth; 5/6th week of pregnancy persistent fullness and tenderness as areola and gland enlarger and darken; placenta stimulates hormones to complete duct system by second trimester; secretion of colostrum (~16 wks) but pregnancy hormones inhibit copious milk production What are the essential units for lactation? alveoli: the secretory acini units responsible for milk production; myoepithelial cells cause ejection of milk into ductules surrounding alveolus and series of ductules merge into a larger collecting duct called lactiferous duct Mary asks you what is the MOST EFFECTIVE way to increase her milk supply? Hand express after feeds [milk synthesis works by supply and demand so most important regulatory mechanism is frequent and thorough milk removal] Where is the tip of the mother's nipple placed in the baby's mouth, when a baby is properly latch on? At juncture of hard and soft palates What may cause strong newborn preference in side for feeding? fractured clavicle, cephalhematoma, subtle positioning difference [any birth injury may be painful placing sore side higher than normal may reduce pain, breasts also differ in configuration and one breast may be easier for baby to nurse from] The MOST COMMON cause of inadequate milk supply is: inadeuqate or infrequent milk removal [persistent milk stasis is chief case of suppressed lactation, frequent & thorough removal of milk is necessary to sustain lactation] B-R-E-A-S-T Assessment Body Position Responses Emotional Bonding Anatomy Suckling Times Swallowed When should initiation occur? encouraged as soon as both mother and baby are physically and emotionally ready; continuous and uninterrupted skin to skin; magical hour: birth cry, relaxation, awakening (3 min), activity (8 min), rest, crawling (35 min), familiarization (45 min), suckling (1 hr), sleep Skin to Skin natural habitat with closeness to mother's heartbeat and voice; provides physiologic stability (respiration, oxygen, glucose, warmth, decreases cortisol, regulates BP, decreased crying, increased quiet alert state), promotes maternal attachmennt behaviors (increased oxytocin), protects from negative effects of separation, supports optimal brain growth, increases breastfeeding rates and duration Name three different holds for breastfeeding. infant-led (semi-reclined, on stomach), football/clutch, cross cradle, side lying, nurturing/laidback, australian/saddle, cradle/madonna -- mother in comfortable position w/ good alignment, bring baby to breast not breast to baby, hand not on hack of head but supported so neck is chin to chest, nose and mouth aligned with areola, body well supported, straight alignment, support weight of breast (most newborns do not have enough strength to maintain position on heavy breast Breast Holds fingers need to be far enough back to allow full access to areola; C-hold with thumb on top and four fingers below; scissor hold; dancer hold with baby's chin resting in fleshy part between thumb and index finger Latch-On baby draws breast into mouth; consider maternal comfort, areolar latch, and good milk transfer - nipple extends to or close to juncture between hard and soft palate; mouth should be wide open with both lips flared outward Signs of Milk Transfer swallowing - puff of air from nose, "ca" sound, deeper jaw excursion, slight movement in front of ear, top of areola moves inward; effective suckling requires coordination of sucking, swallowing, and breathing What feeding cue does the infant exhibit last? Fussing/Crying - difficult to soothe may demonstrate disorganized feeding behavior (other include rooting-opening mouth in resposne to tactile stimulation; sucking motions/sounds; motor activity including clenching or unclenching hands, raising arms, moving legs; lip smacking; hands to mouth) Satiety Cues decrease in sucks, pursed lips pulling away from breast, contented state with relaxed body, small amount of milk in mouth What is cluster feeding and when does it occur? think carry mammals; baby feeds frequently in a short amount of time - first 24-48 hours ( 48 hrs on demand, cue based feeding every 3 hrs and try again within 30-60 min) What is the basic principle behind milk production? supply and demand, hand expression, and avoiding supplementation What should a mother do during a "growth spurt"? predictable times when infant's needs for increased calories seen lasting for 24-48 hrs (3 days, 2 weeks, 6 weeks, 3 months); instruct to allow babies to nurse unrestricted in order to increase milk supply How long does it usually take for a healthy newborn to regain his birth weight? 2-3 weeks What is normal weight loss for a healthy infant during the first 3-4 days of life? dt sheeding of excess fluids in tissues and passage of meconium; 5-7% is normal; 10% indicates need for intervention What would be the expected minimal output of a two day old infant? normal output is one wet diaper per day of life until "milk comes in" - 2 wet diapers (babies need at least 8 feeds per 24 hours) Keisha is a breastfeeding mother who asks you what she needs to be sure that her diet includes: her normal intake of food and drink Jennifer is hesitant to breastfeed because she heard that she needs to eat a high-calorie, nutrient-rich diet during lactation. Your BEST response is: women living under a variety of circumstances are capable of fully nourishing their infants by breastfeeding Amanda is a breastfeeding mother of a toddler who is also pregnant. Which suggestions are relevant? eat enough calories of a basic mixed diet, gain weight within the same parameters as if you were pregnant and not breastfeeding, consider any other special dietary needs What is the recommended caloric intake for lactating women? 2700 calories (most usually consume 2200, minimum safe is 1800); eat and drink when hungry and thirsty with focus on variety of foods and water State three ways to make nutrition easy for lactating women. assess health history, evaluate diet, be supportive and offer options for healthy food choices without rigid rules (50-55% carbs, 12-15% protein, 20-30% fat) How many calories are needed for milk production? 500 daily calories What are some assessment considerations when a breastfeeding mother is a vegan? risk for vitamin B12 deficiency; may also be decrease in vitamins A, D, and B6 Vitamin D and Breastfeeding supplement of 400 IU per day of vitamin D recommended for all breastfed infants Grace is a breastfeeding mother who is complaining of a lump in her breast. Which characteristic is LEAST LIKELY to be related to lactation? the lump does not change size before and after the baby feeds Martin is a healthy, thriving 10-day old newborn who has bilirubin of 12. The FIRST suggestion for this baby's care should be: continue 10-12 effective breastfeedings every day