ALPP CLC Exam 2 (Actual Exam 2026) | Certified Lactation
Counselor Exam) | Academy of Lactation Policy and
Practice (ALPP) | Complete Questions and Correct Answers
Question 1
Which hormone is primarily responsible for milk ejection (let-down reflex)?
A) Prolactin
B) Estrogen
C) Oxytocin
D) Progesterone
E) Growth Hormone
Correct Answer: C) Oxytocin
Rationale: Oxytocin is the hormone responsible for the milk ejection
reflex, causing the myoepithelial cells around the alveoli to contract
and push milk into the ducts.
Question 2
What is the primary role of prolactin in lactation?
A) To trigger the milk ejection reflex.
B) To suppress milk production during pregnancy.
C) To stimulate milk synthesis by the alveolar cells.
D) To cause uterine contractions.
E) To promote maternal-infant bonding.
Correct Answer: C) To stimulate milk synthesis by the alveolar cells.
Rationale: Prolactin is the key hormone that stimulates the alveolar
cells in the breast to synthesize milk.
Question 3
The first milk produced by the mother after childbirth, rich in
immunoglobulins, is called:
A) Transitional milk
B) Mature milk
C) Foremilk
D) Colostrum
E) Hindmilk
,Correct Answer: D) Colostrum
Rationale: Colostrum is the first milk, often yellowish and thick,
produced in the immediate postpartum period, packed with
antibodies and growth factors essential for the newborn.
Question 4
Lactogenesis I is characterized by:
A) A rapid drop in progesterone and onset of copious milk production.
B) Secretory differentiation, placental hormones, and colostrum production.
C) Stable milk production several weeks postpartum.
D) Increased fat content at the end of a feed.
E) Suppression of milk synthesis.
Correct Answer: B) Secretory differentiation, placental hormones, and
colostrum production.
Rationale: Lactogenesis I, also known as secretory differentiation, is
the stage during pregnancy when the mammary glands develop the
ability to produce milk, influenced by placental hormones, and
results in colostrum production.
Question 5
What triggers Lactogenesis II (secretory activation)?
A) High levels of estrogen.
B) A rapid drop in progesterone levels after the complete delivery of the
placenta.
C) Frequent nipple stimulation during pregnancy.
D) Increased prolactin levels during pregnancy.
E) Baby's first suckle at the breast.
Correct Answer: B) A rapid drop in progesterone levels after the
complete delivery of the placenta.
Rationale: Lactogenesis II, or secretory activation, is triggered by the
rapid drop in progesterone levels that occurs after the complete
,delivery of the placenta, leading to a significant increase in milk
volume (transitional milk).
Question 6
Which component of breastmilk helps protect infants from pathogens by
depriving bacteria of iron?
A) SIgA
B) Lysozyme
C) Lactoferrin
D) Bifidus factor
E) White blood cells
Correct Answer: C) Lactoferrin
Rationale: Lactoferrin is a protein in breastmilk that binds iron,
making it unavailable to bacteria, thus inhibiting bacterial growth.
Question 7
The "bifidus factor" in breastmilk promotes the growth of which beneficial
bacteria in the infant's gut?
A) E. coli
B) Staphylococcus aureus
C) Lactobacillus bifidus
D) Clostridium difficile
E) Streptococcus mutans
Correct Answer: C) Lactobacillus bifidus
Rationale: The bifidus factor in breastmilk specifically promotes the
growth of Lactobacillus bifidus, which helps maintain a low pH in the
gut and crowds out pathogenic organisms.
Question 8
Why is exclusive breastfeeding (EBF) considered a significant protection
against diarrhea in infants?
A) It introduces more beneficial bacteria into the gut.
B) It makes the infant's gut more acidic, hindering pathogen growth.
, C) It has a higher iron content that kills pathogenic bacteria.
D) It contains prebiotics that pathogens cannot digest.
E) It eliminates exposure to contaminated bottles, teats, and water.
Correct Answer: E) It eliminates exposure to contaminated bottles,
teats, and water.
Rationale: EBF provides protection from diarrhea through multiple
mechanisms, including the absence of exposure to contaminants
(bottles, teats, water) and formula ingredients that can introduce
pathogens.
Question 9
A common finding in infants experiencing inadequate milk transfer during
breastfeeding is:
A) Significant weight gain.
B) Frequent, large urine output.
C) Breastfeeding associated hypernatremia.
D) Decreased bilirubin levels.
E) High blood glucose levels.
Correct Answer: C) Breastfeeding associated hypernatremia.
Rationale: Breastfeeding associated hypernatremia is a common
complication of inadequate milk transfer, as the infant becomes
dehydrated due to insufficient fluid and nutrient intake, leading to
elevated sodium levels.
Question 10
According to the AAP (2005 stance), weight loss in an infant greater than 7%
from birth weight indicates:
A) Normal physiological weight loss.
B) Possible breastfeeding problems requiring evaluation and intervention.
C) Rapid metabolism.
D) Excellent milk production.
E) No need for concern if the baby is contented.
Counselor Exam) | Academy of Lactation Policy and
Practice (ALPP) | Complete Questions and Correct Answers
Question 1
Which hormone is primarily responsible for milk ejection (let-down reflex)?
A) Prolactin
B) Estrogen
C) Oxytocin
D) Progesterone
E) Growth Hormone
Correct Answer: C) Oxytocin
Rationale: Oxytocin is the hormone responsible for the milk ejection
reflex, causing the myoepithelial cells around the alveoli to contract
and push milk into the ducts.
Question 2
What is the primary role of prolactin in lactation?
A) To trigger the milk ejection reflex.
B) To suppress milk production during pregnancy.
C) To stimulate milk synthesis by the alveolar cells.
D) To cause uterine contractions.
E) To promote maternal-infant bonding.
Correct Answer: C) To stimulate milk synthesis by the alveolar cells.
Rationale: Prolactin is the key hormone that stimulates the alveolar
cells in the breast to synthesize milk.
Question 3
The first milk produced by the mother after childbirth, rich in
immunoglobulins, is called:
A) Transitional milk
B) Mature milk
C) Foremilk
D) Colostrum
E) Hindmilk
,Correct Answer: D) Colostrum
Rationale: Colostrum is the first milk, often yellowish and thick,
produced in the immediate postpartum period, packed with
antibodies and growth factors essential for the newborn.
Question 4
Lactogenesis I is characterized by:
A) A rapid drop in progesterone and onset of copious milk production.
B) Secretory differentiation, placental hormones, and colostrum production.
C) Stable milk production several weeks postpartum.
D) Increased fat content at the end of a feed.
E) Suppression of milk synthesis.
Correct Answer: B) Secretory differentiation, placental hormones, and
colostrum production.
Rationale: Lactogenesis I, also known as secretory differentiation, is
the stage during pregnancy when the mammary glands develop the
ability to produce milk, influenced by placental hormones, and
results in colostrum production.
Question 5
What triggers Lactogenesis II (secretory activation)?
A) High levels of estrogen.
B) A rapid drop in progesterone levels after the complete delivery of the
placenta.
C) Frequent nipple stimulation during pregnancy.
D) Increased prolactin levels during pregnancy.
E) Baby's first suckle at the breast.
Correct Answer: B) A rapid drop in progesterone levels after the
complete delivery of the placenta.
Rationale: Lactogenesis II, or secretory activation, is triggered by the
rapid drop in progesterone levels that occurs after the complete
,delivery of the placenta, leading to a significant increase in milk
volume (transitional milk).
Question 6
Which component of breastmilk helps protect infants from pathogens by
depriving bacteria of iron?
A) SIgA
B) Lysozyme
C) Lactoferrin
D) Bifidus factor
E) White blood cells
Correct Answer: C) Lactoferrin
Rationale: Lactoferrin is a protein in breastmilk that binds iron,
making it unavailable to bacteria, thus inhibiting bacterial growth.
Question 7
The "bifidus factor" in breastmilk promotes the growth of which beneficial
bacteria in the infant's gut?
A) E. coli
B) Staphylococcus aureus
C) Lactobacillus bifidus
D) Clostridium difficile
E) Streptococcus mutans
Correct Answer: C) Lactobacillus bifidus
Rationale: The bifidus factor in breastmilk specifically promotes the
growth of Lactobacillus bifidus, which helps maintain a low pH in the
gut and crowds out pathogenic organisms.
Question 8
Why is exclusive breastfeeding (EBF) considered a significant protection
against diarrhea in infants?
A) It introduces more beneficial bacteria into the gut.
B) It makes the infant's gut more acidic, hindering pathogen growth.
, C) It has a higher iron content that kills pathogenic bacteria.
D) It contains prebiotics that pathogens cannot digest.
E) It eliminates exposure to contaminated bottles, teats, and water.
Correct Answer: E) It eliminates exposure to contaminated bottles,
teats, and water.
Rationale: EBF provides protection from diarrhea through multiple
mechanisms, including the absence of exposure to contaminants
(bottles, teats, water) and formula ingredients that can introduce
pathogens.
Question 9
A common finding in infants experiencing inadequate milk transfer during
breastfeeding is:
A) Significant weight gain.
B) Frequent, large urine output.
C) Breastfeeding associated hypernatremia.
D) Decreased bilirubin levels.
E) High blood glucose levels.
Correct Answer: C) Breastfeeding associated hypernatremia.
Rationale: Breastfeeding associated hypernatremia is a common
complication of inadequate milk transfer, as the infant becomes
dehydrated due to insufficient fluid and nutrient intake, leading to
elevated sodium levels.
Question 10
According to the AAP (2005 stance), weight loss in an infant greater than 7%
from birth weight indicates:
A) Normal physiological weight loss.
B) Possible breastfeeding problems requiring evaluation and intervention.
C) Rapid metabolism.
D) Excellent milk production.
E) No need for concern if the baby is contented.
