Certified Breastfeeding Counselor (CBC) Actual
Practice Exam & Certification Preparation: Complete
Questions with Verified Answers
SECTION 1: Breastfeeding Physiology & Management (Questions 1-20)
Q1: A mother at 36 hours postpartum reports her breasts are "filling up" and feeling
tight. Her baby is 48 hours old and has had 3 wet diapers in the past 24 hours. She asks
if she should pump to relieve the pressure. Your BEST response is:
A) "Yes, pump for 10 minutes after each feeding to empty your breasts completely."
B) "Pump only if your baby doesn't soften the breast after feeding, but limit to 2-3
minutes to relieve pressure."
C) "Avoid pumping entirely; it will just make you produce more milk and worsen the
engorgement."
D) "Apply ice packs and take ibuprofen; pumping isn't necessary."
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: ABM Protocol #20: "Engorgement management focuses on
frequent milk removal and comfort measures. Brief hand expression or pumping
(2-3 minutes) may soften the areola to facilitate latch without creating
oversupply."
● Counseling Approach: Validate her discomfort while providing specific, limited
guidance that empowers her to manage engorgement without disrupting
supply-demand balance.
● Physiological Rationale: Lactogenesis II typically occurs 30-40 hours postpartum.
The 3 wet diapers indicate adequate intake. Complete emptying through
pumping (Option A) signals additional production, worsening engorgement.
Option C is too restrictive—some expression may be needed for latch. Option D
ignores milk removal which is essential for resolution.
, ● Safety/Scope: If latch is impossible due to engorgement or output decreases,
referral to IBCLC is warranted. The mother should be taught reverse pressure
softening.
Q2: You observe a feeding with a 5-day-old infant. The mother is sitting upright, holding
the baby cross-cradle with the infant's body turned away from her. The baby is making
smacking sounds and the mother's nipple appears pinched after the feed. Your FIRST
recommendation should be:
A) "Switch to football hold to get a better view of the latch."
B) "Let's try biological nurturing—reclining back and letting the baby lie prone on you."
C) "The baby may have tongue tie; you should see a specialist."
D) "Use a nipple shield until your nipples heal."
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: Biological Nurturing research (Colson, 2010): "Prone
positioning triggers innate feeding reflexes and often corrects shallow latch
without complex positioning techniques."
● Counseling Approach: Offer a simple, comfortable adjustment before diagnosing
pathology or introducing devices. Demonstrate confidence in the baby's innate
abilities.
● Physiological Rationale: The described position (body turned away) creates
mechanical difficulties for swallowing. Laid-back breastfeeding utilizes gravity to
keep the baby close, stimulates 20+ primitive neonatal reflexes ( rooting, seeking,
sucking), and typically results in deeper attachment naturally.
● Safety/Scope: While tongue tie (C) is possible, positioning corrections should
always be attempted first. Nipple shields (D) require IBCLC fitting and may
compromise transfer if underlying latch isn't addressed.
Q3: A mother reports her 3-week-old nurses for exactly 10 minutes on each side every 3
hours, per the hospital nurse's instructions. The baby is gaining 4 oz/week. Your
assessment is:
A) The feeding pattern is appropriate since weight gain is adequate.
B) The rigid timing may limit fat-rich hindmilk intake and you should recommend
flexible, baby-led feeding.
C) You should recommend extending feeds to 20 minutes per side.
D) The mother needs to wake the baby to feed every 2 hours to increase gain.
,Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: AAP Policy Statement: "Watch the baby, not the clock."
Infant-led feeding optimizes fat intake and supply regulation.
● Counseling Approach: Affirm the adequate weight gain while gently challenging
rigid protocols that may become problematic as the baby grows. Use "and/both"
language.
● Physiological Rationale: While weight gain is currently acceptable (borderline
low—normal is 0.5-1 oz/day or 3.5-7 oz/week), scheduled feeding can lead to
foremilk/hindmilk imbalance and doesn't allow for cluster feeding during growth
spurts. Fat content increases as the breast empties; arbitrary switching limits
high-caloric milk intake.
● Safety/Scope: This is within CBC scope to educate on feeding cues. However, if
weight gain drops below 4 oz/week, IBCLC referral is indicated.
Q4: Regarding prolactin receptor theory, which statement is MOST accurate for
counseling a mother with perceived low supply at 4 weeks?
A) "The more milk you remove now, the more receptors you create, increasing long-term
supply capacity."
B) "At 4 weeks, your supply is established and pumping won't increase it."
C) "Prolactin levels only matter in the first 72 hours postpartum."
D) "You need to take prolactin supplements to increase receptors."
Correct Answer: A
100% CORRECT RATIONALE:
● Evidence Source: lactation physiology research (Kent et al., 2006): "Frequent milk
removal in early weeks upregulates prolactin receptors, establishing higher
potential milk production capacity throughout lactation."
● Counseling Approach: Empower the mother with physiological understanding
that her efforts matter, without creating pressure or guilt.
● Physiological Rationale: Prolactin receptor proliferation is highest in the first 4-6
weeks. Each emptying increases receptor sites on lactocytes, effectively
"programming" the breast for higher future production. This explains why early
frequent feeding/pumping benefits supply even if output seems low initially.
, ● Safety/Scope: This education helps mothers understand why cluster feeding and
night feeding support supply. If supply issues persist despite optimization,
medical evaluation (thyroid, retained placenta) is needed—refer to physician.
Q5: A mother describes intense, burning nipple pain that occurs after feeding and
radiates into the breast. Her nipples blanch white and then turn purple before returning
to pink. The latch appears deep and asymmetric. Your differential diagnosis is:
A) Candida infection (thrush)
B) Raynaud's phenomenon of the nipple (vasospasm)
C) Bacterial mastitis
D) Poor latch causing compression pain
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: ABM Protocol #26: "Vasospasm presents as triphasic color
change (white-blue-red) and burning pain between feeds, distinct from latch pain
which occurs during feeding."
● Counseling Approach: Validate the severity of pain while offering specific
environmental modifications. Differentiate from thrush to avoid unnecessary
antifungal treatment.
● Physiological Rationale: Raynaud's involves smooth muscle spasm of nipple
arterioles triggered by temperature change or latch trauma. The color change
(white→purple→pink) is pathognomonic. Latch pain (D) resolves when baby
unlatches; thrush (A) typically involves shiny, flaky nipples and shooting breast
pain without color changes; mastitis (C) presents with fever and localized
erythema.
● Safety/Scope: Recommend warming techniques, magnesium supplementation,
and nifedipine discussion with physician. Rule out mechanical compression from
latch trauma as contributing factor.
Q6: You are assessing intake for a 10-day-old infant. Which finding requires IMMEDIATE
referral to the pediatrician?
A) Three yellow, seedy stools in 24 hours
B) Six wet diapers with pale yellow urine
C) 8% weight loss from birth with steady gain since day 5
D) Dark, concentrated urine (orange crystals) and lethargy
Practice Exam & Certification Preparation: Complete
Questions with Verified Answers
SECTION 1: Breastfeeding Physiology & Management (Questions 1-20)
Q1: A mother at 36 hours postpartum reports her breasts are "filling up" and feeling
tight. Her baby is 48 hours old and has had 3 wet diapers in the past 24 hours. She asks
if she should pump to relieve the pressure. Your BEST response is:
A) "Yes, pump for 10 minutes after each feeding to empty your breasts completely."
B) "Pump only if your baby doesn't soften the breast after feeding, but limit to 2-3
minutes to relieve pressure."
C) "Avoid pumping entirely; it will just make you produce more milk and worsen the
engorgement."
D) "Apply ice packs and take ibuprofen; pumping isn't necessary."
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: ABM Protocol #20: "Engorgement management focuses on
frequent milk removal and comfort measures. Brief hand expression or pumping
(2-3 minutes) may soften the areola to facilitate latch without creating
oversupply."
● Counseling Approach: Validate her discomfort while providing specific, limited
guidance that empowers her to manage engorgement without disrupting
supply-demand balance.
● Physiological Rationale: Lactogenesis II typically occurs 30-40 hours postpartum.
The 3 wet diapers indicate adequate intake. Complete emptying through
pumping (Option A) signals additional production, worsening engorgement.
Option C is too restrictive—some expression may be needed for latch. Option D
ignores milk removal which is essential for resolution.
, ● Safety/Scope: If latch is impossible due to engorgement or output decreases,
referral to IBCLC is warranted. The mother should be taught reverse pressure
softening.
Q2: You observe a feeding with a 5-day-old infant. The mother is sitting upright, holding
the baby cross-cradle with the infant's body turned away from her. The baby is making
smacking sounds and the mother's nipple appears pinched after the feed. Your FIRST
recommendation should be:
A) "Switch to football hold to get a better view of the latch."
B) "Let's try biological nurturing—reclining back and letting the baby lie prone on you."
C) "The baby may have tongue tie; you should see a specialist."
D) "Use a nipple shield until your nipples heal."
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: Biological Nurturing research (Colson, 2010): "Prone
positioning triggers innate feeding reflexes and often corrects shallow latch
without complex positioning techniques."
● Counseling Approach: Offer a simple, comfortable adjustment before diagnosing
pathology or introducing devices. Demonstrate confidence in the baby's innate
abilities.
● Physiological Rationale: The described position (body turned away) creates
mechanical difficulties for swallowing. Laid-back breastfeeding utilizes gravity to
keep the baby close, stimulates 20+ primitive neonatal reflexes ( rooting, seeking,
sucking), and typically results in deeper attachment naturally.
● Safety/Scope: While tongue tie (C) is possible, positioning corrections should
always be attempted first. Nipple shields (D) require IBCLC fitting and may
compromise transfer if underlying latch isn't addressed.
Q3: A mother reports her 3-week-old nurses for exactly 10 minutes on each side every 3
hours, per the hospital nurse's instructions. The baby is gaining 4 oz/week. Your
assessment is:
A) The feeding pattern is appropriate since weight gain is adequate.
B) The rigid timing may limit fat-rich hindmilk intake and you should recommend
flexible, baby-led feeding.
C) You should recommend extending feeds to 20 minutes per side.
D) The mother needs to wake the baby to feed every 2 hours to increase gain.
,Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: AAP Policy Statement: "Watch the baby, not the clock."
Infant-led feeding optimizes fat intake and supply regulation.
● Counseling Approach: Affirm the adequate weight gain while gently challenging
rigid protocols that may become problematic as the baby grows. Use "and/both"
language.
● Physiological Rationale: While weight gain is currently acceptable (borderline
low—normal is 0.5-1 oz/day or 3.5-7 oz/week), scheduled feeding can lead to
foremilk/hindmilk imbalance and doesn't allow for cluster feeding during growth
spurts. Fat content increases as the breast empties; arbitrary switching limits
high-caloric milk intake.
● Safety/Scope: This is within CBC scope to educate on feeding cues. However, if
weight gain drops below 4 oz/week, IBCLC referral is indicated.
Q4: Regarding prolactin receptor theory, which statement is MOST accurate for
counseling a mother with perceived low supply at 4 weeks?
A) "The more milk you remove now, the more receptors you create, increasing long-term
supply capacity."
B) "At 4 weeks, your supply is established and pumping won't increase it."
C) "Prolactin levels only matter in the first 72 hours postpartum."
D) "You need to take prolactin supplements to increase receptors."
Correct Answer: A
100% CORRECT RATIONALE:
● Evidence Source: lactation physiology research (Kent et al., 2006): "Frequent milk
removal in early weeks upregulates prolactin receptors, establishing higher
potential milk production capacity throughout lactation."
● Counseling Approach: Empower the mother with physiological understanding
that her efforts matter, without creating pressure or guilt.
● Physiological Rationale: Prolactin receptor proliferation is highest in the first 4-6
weeks. Each emptying increases receptor sites on lactocytes, effectively
"programming" the breast for higher future production. This explains why early
frequent feeding/pumping benefits supply even if output seems low initially.
, ● Safety/Scope: This education helps mothers understand why cluster feeding and
night feeding support supply. If supply issues persist despite optimization,
medical evaluation (thyroid, retained placenta) is needed—refer to physician.
Q5: A mother describes intense, burning nipple pain that occurs after feeding and
radiates into the breast. Her nipples blanch white and then turn purple before returning
to pink. The latch appears deep and asymmetric. Your differential diagnosis is:
A) Candida infection (thrush)
B) Raynaud's phenomenon of the nipple (vasospasm)
C) Bacterial mastitis
D) Poor latch causing compression pain
Correct Answer: B
100% CORRECT RATIONALE:
● Evidence Source: ABM Protocol #26: "Vasospasm presents as triphasic color
change (white-blue-red) and burning pain between feeds, distinct from latch pain
which occurs during feeding."
● Counseling Approach: Validate the severity of pain while offering specific
environmental modifications. Differentiate from thrush to avoid unnecessary
antifungal treatment.
● Physiological Rationale: Raynaud's involves smooth muscle spasm of nipple
arterioles triggered by temperature change or latch trauma. The color change
(white→purple→pink) is pathognomonic. Latch pain (D) resolves when baby
unlatches; thrush (A) typically involves shiny, flaky nipples and shooting breast
pain without color changes; mastitis (C) presents with fever and localized
erythema.
● Safety/Scope: Recommend warming techniques, magnesium supplementation,
and nifedipine discussion with physician. Rule out mechanical compression from
latch trauma as contributing factor.
Q6: You are assessing intake for a 10-day-old infant. Which finding requires IMMEDIATE
referral to the pediatrician?
A) Three yellow, seedy stools in 24 hours
B) Six wet diapers with pale yellow urine
C) 8% weight loss from birth with steady gain since day 5
D) Dark, concentrated urine (orange crystals) and lethargy
