CBC Exam Questions and Answers

CBC Exam Questions and Answers A healthcare provider wants to encourage pregnant women to choose breastfeeding. What statement is MOST supportive? A) Are you considering breastfeeding? B) What have you heard about breastfeeding? C) Are you going to breastfeed or bottle feed? D) You aren't thinking about breastfeeding are you? B) What have you heard about breastfeeding? This is an open ended question and allows the provider to explore moms ideas of breastfeeding You work in a clinic 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: A) Try to intercept the client seen by her and correct the misinformation B) Form a committee to develop written protocol on all aspect of lactation practice for your clinic C) Bring in research evidence of the harmful nature of this practice and discuss it with her D) Lodge a complaint with the IBCLC C) Bring in research evidence of the harmful nature of this practice and discuss it with her Standards of practice for breastfeeding counselors include what four areas? 1) Clinical practice ( assessment, plan, implementation, and evaluation) 2) Breastfeeding education and counseling 3) Professional responsibilities 4) Legal considerations What can effect the healthcare professionals presentation about breastfeeding? Personal philosophy/experience, continuity of care/lack of, education/misconception According to AWHONN, what are some of the responsibilities of staff nurses working with breastfeeding women? Providing education aimed at successful initiation and maintenance of breastfeeding. Which of the following activities is permissible under the terms of WHO's international code of marketing of breast milk substitutes? A) Advertising for toddler formula on local television stations B) Picture of a happy baby on the label of infant formula containers C) Gift packs containing samples of formula given to new mothers at hospital discharge D) Detailed information on product composition provided to heath workers D) Detailed information on product composition provided to healthcare workers The Code specifies that information on artificial feeding provided to healthcare workers should be scientific and accurate. A cultural attitude that emphasizes the sexual nature of breasts is MOST LIKELY associated with: A) Conflicts in custody disputes involving breastfeeding babies B) Decreased breast reduction surgery C) Harassment for breastfeeding in public D) Mothers enjoying the attention created by larger breasts during lactation C) Harassment for breastfeeding in public Cultures that sexualize breasts are often the most resistant to women using their breasts to feed their infants anywhere. Which organization was the first in the United States to provide mother to mother support? La Leche League (LLL) List the ten points of "The Ten Steps to Successful Breastfeeding for Hospitals" as outlined by UNICEF and WHO? 1) Have a written breastfeeding policy that is routinely communicated to the healthcare staff 2) Train all healthcare staff in skills necessary to implement this policy 3) Inform all pregnant women about the benefits and management of breastfeeding 4) Help mother initiate breastfeeding within an hour of birth 5) Show mothers how to breastfeed and how how to maintain lactation even if they should be separated from their infants 6) Give newborn infants no food or drink other than breastmilk, unless medically indicated 7) Practice rooming in by allowing mothers and babies to remain together 24 hours a day 8) Encourage breastfeeding on demand 9) Give no artificial teats pacifiers, dummies, or soothers to breastfeeding infants 10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge Name some reasons why formula feeding replaced breastfeeding Sexualization of breasts, lack of support, the "status" of paying for formula, and cultural beliefs 26 year old Sarah is having her first baby in four weeks. She asks her healthcare provider if she will be able to breastfeed after having a breast reduction with her nipple auto-transplanted at an earlier age. The BEST response is: A) It may be possible for the first three months B) She should try and see what happens C) There will be no problem breastfeeding D) She wont be able to due to nerve damage B) Try and see what happens No assumptions can be made about her ability to breastfeed after breast surgery. She should be followed closely for the first four weeks postpartum because the surgery can disrupt ducts and nerve pathways. Accessory nipple or breast tissue is LEAST LIKELY to be found in which of the following locations? A) Near the umbilicus B) Inguinal region C) Axilla D) Outer thigh D) Outer thigh The other areas may have extra mammary and/or nipple tissue, which are remnants of the galactic band. Which is the primary or main Immunoglobulin found in human milk? A) IgA B) IgG C) IgE D) IgM A) IgA This is found in large quantities in human milk, protecting the entire GI system. The other immunoglobulins are present in lower proportions. Which component of human milk is MOST variable? Lipids are the most variable component. The proportion of fat in milk increases as the breast empties, and there is a slight variation in fatty acid profiles with maternal diet. Elements like minerals, carbs, and proteins are stable over the course of the day and duration of breastfeeding. Which component of human milk is destroyed by freezing? Macrophages are living cells and therefore killed by freezing. Lysozyme, secretory IgA, and lactoferrin are not significantly effected by freezing. What hormones influence changes in the lactating breast? Estrogen: The increase in pregnancy encourages the ductal system to grow. Progesterone: Stimulates the growth of the alveoli and lobes while suppressing secretory activity. Prolactin: Essential for the initiation and maintenance of milk production. Oxytocin: Triggers MER/letdown. TSH: Increases the responsiveness of mammary cells to prolactin and can improve lactation performance. What event riggers Lactogenesis stage 2? Passing the placenta What are some considerations when assessing the nipple? Aerolar hair, this is normal. Tail of Spence, mammary glandular tissue that extends to the axillary region. This is a potential for breast milk pooling and mastitis, Accessory breast/nipple tissue/hypermastia, accessory glandular tissue that can be anywhere along the mammary ridge. The mammary ridge extends from the axilla to the groin and labia. Flat nipples/Inverted nipples Abnormally shaped breasts (hypoplasia) Implants, hyaluronic acid injections, breast reduction Pierced nipples What are some assessment considerations if a woman has had a breast reduction? Breast feeding may not always be possible. It depends on the surgical technique, amount of glandular tissue removed, and the resultant integrity of blood supply and nerve pathways. Techniques: Pedicle, free nipple (nerve damage), and liposuction Woman with reductions should breastfeed early and often, and the infant should be monitored closely as supplementation may be needed. What are the major components of breastmilk? Proteins, fats, carbs, vitamins, and minerals Name three ways to stimulate milk ejection reflex 1) Infant suckling 2) Manual expression 3) Emotional responses What are the signs that MER has occurred? Tingling in the breasts A feeling of warmth or fullness in the breasts Drippling milk before the infant begins to nurse Release of milk from the nipple other than the one being suckled Uterine contractions Relief of nipple or breast discomfort as infant nurses What is the largest component of breast milk? Water (88%) When should initiation of breastfeeding occur? As soon as mother and baby are both physically and emotionally ready What are three different holds for breastfeeding? Football/clutch Australian/saddle Biological nurturing/laidback Cradle/Madonna Side lying What feeding cues does the infant exhibit last? Crying What is cluster feeding and when does it occur? When baby feeds frequently and for short amounts of time. This occurs typically 24-48 hours after birth. What is the basic principal behind breastmilk production? Supply and demand What should a mother do during a "growth spurt"? Allow baby to feed unrestricted to increase milk supply. How long does it usually take for a healthy newborn to regain his birth weight? Within two to three weeks of age What is normal weight loss for a healthy infant during the first three to four days of life? 5-7% What would be the expected output for a two day old infant? Two diapers Output should be one wet diaper per day of life for the first week/ when the "milk comes in" Mary asks you what is the MOST EFFECTIVE way to increase her milk supply A) Drink more fluids B) Take fenugreek capsules C) Hand express after feeds D) Eat more food C) Hand express after feeds Where is the tip of the mother nipple placed in the baby's mouth when a baby is properly latched? A) The center of the soft palate B)The juncture of the hard and soft palate C) The center of the hard palate D) Just behind the upper gum ridge B)The juncture of the hard and soft palate Rena calls you, frustrated because her three week old baby's preference for nursing at the right breast is so strong that she is unable to get him to nurse on her left side. What is the LEAST LIKLEY explanation for this behavior? A) Infant has a right clavicle fracture B) Infant has a cephalohematoma on the right side C)The mother has undetected cancer in her left breast D) There is a subtle positioning difference in the mothers hold on her left side C)The mother has undetected cancer in her left breast The MOST COMMON cause of inadequate milk supply is: A) Impaired let-down reflex B) Restricted maternal fluid intake C) Inadequate or infrequent milk removal D) Inadequate maternal diet C) Inadequate or infrequent milk removal Keisha is a breastfeeding mother who asks you what she needs to be sure that her diet includes: A) Plenty of liquids to ensure sufficient milk volume B) Additional b vitamins C) Her normal intake of food and drink D) An extra 1200 calories per day C) Her normal intake of food and drink Jenifer is hesitant to breastfeed because she heard that she needs to eat a high-calorie, nutrient-rich diet during lactation. Your BEST response is A) Women living under a variety of circumstances are capable of fully nourishing their infants by breastfeeding B) Refer her to a supplemental food program to assure adequate nutrient intake C)Provide her a multivitamin and mineral supplement D) Discourage her from breastfeeding as her current circumstances make it doubtful she is eating adequately A) 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. She asks you if she needs special dietary considerations to "eat for three" while she is pregnant. Which suggestion is IRRELEVANT A) Double your protein B) eat enough calories of a basic mixed diet C) Gain weight within the same parameters as if you were pregnant and not breastfeeding D) Do you ordinarily have special dietary needs? A) Double your protein Pregnant women do not need extra protein if they are lactating What is the recommended caloric intake for lactating women? , no fewer than 1800 How can you make nutrition easier for lactating women? Eat based on hunger rather than calorie counting Have nutritious, easy to fix foods available such as cheese, yogurt, fresh fruits, boiled eggs, nuts, and whole grain bread Have a water bottle or pitcher available whenever sitting down to nurse How many calories are needed for milk production? 500 What are some assessment considerations when a breastfeeding mother is vegan? Infants are at a higher risk for B12 deficiency and a decrease in vitamins A, D, and B6. Supplementation may be required. Grace is a breastfeeding mother who is complaining of a lump in her breast. Which characteristic is LEAST LIKLEY to be related to lactation? A) The lump does not change size after baby feeds B) The skin over the lump is red and warm C) The mother began running a low grade fever the same time it appeared D) The lump feels like a soft fluid filled sac A) The lump does not change size after baby feeds Martin is a healthy, thriving, 10 day old newborn who has a bilirubin level of 12.0 mg/dL. The FIRST suggestion for this baby's care should be: A) Replace most of the feeds with formula B) Institute phototherapy except during feeds C) Continue 10-12 effective breastfeedings every day D) Have the baby spend several sessions undressed in a sunny window C) Continue 10-12 effective breastfeedings every day Carrie had surgery to drain a breast abscess. What is the MOST IMPORTANT contributing factor to a breast abscess? A) Partial formula feeding B)Maternal influenza C) Sore nipples D) Prolonged milk stasis D) Prolonged milk stasis What is ankyloglossia? Tongue tied, a thick lingual frenum resulting in limitation of tongue movement. What are some management strategies for sore nipples? Feed baby on the less tender side first Warm, moist compresses Express breast milk and allow to air dry Lanolin Nipple ointments Gel dressings (hydrogel) Salt water soaks What are predisposing factors of a breast abscess? Prior mastitis, a delay in treatment for mastitis, noncompliance with antibiotic therapy, antibiotic resistance, wrong antibiotics chosen, failure to drain the affected breast, and abrupt weaning What causes breast engorgement? Vascular dilation as well as the presence of early milk. It involves three elements: 1) Congestion and increased vascularity 2) Physiological response to the removal of the placenta 3)Edema - secondary to swelling and obstruction of the lymphatic system How does green cabbage treat engorgement? Green cabbage contains sinigrin rapine, mustard oil, magnesium, oxalate and sulphur heteroside. These have both antibiotic and anti-irritant properties. This will soften and decrease the swelling of the breasts. What are the signs of mastitits? Increased fatigue Flu- like symptoms Fever of 101.3 or greater Localized breast pain that can become hot, red and tender What are some management strategies for a mother who is diagnosed with mammary candidiasis? Wash bra and breast pads daily Wash nipples with soap and water if cracked Rinse nipples with water and vinegar after feedings Nystatin Clotrimazole Miconazole Gentian violet Jack Newman's all-purpose nipple ointment If listed topicals do not bring relief, oral fluconazole can be taken for 14-28 days Assessment considerations for infants diagnosed with hyperbilirubinemia Infant may have cephalohematoma or significant bruising, excessive weight loss, jaundiced skin Assess latch, quality of breastfeeding Assess infant for weight loss, vigor, evidence of dehydration and general appearance You are asked to evaluate a baby's ability to breastfeed before discharge following and uncomplicated hospital birth 12 hours ago. The baby weighs about 2700g or 6lbs. Which of the following characteristics of her sucking would lead you to believe this baby was NOT born at term? A) Moves smoothly from rooting behavior to latch on B) Sucks, swallows, and breathes with a coordinated rhythm C) Sucks in short bursts with pauses D) Begins to suck rapidly, then slows to a steady rhythm C) Sucks in short bursts with pauses Short sucks with a pause are an indicator of an immature infant, the others are all things a mature infant may do during feeding You are working with a late preterm infant born at 34 weeks gestation who has been in the NICU since birth 10 days ago. The baby falls readily asleep at breast each time you assist mom to latch. Her milk supply is plentiful due to pumping. What is the MOST LIKELY cause for this infant to be unable to sustain his latch at breast? A) His suck has low intraoral pressure due to gestational age B) Prematurity causes sleepiness at breast until 40 weeks gestation C) This infant was fed with a bottle during his NICU stay D) The mother has delayed lactogenesis resulting from her premature delivery A) His suck has low intraoral pressure due to gestational age Intensity of suction increases with gestational age, however waiting to attempt breast feeding till 40 weeks is not recommended. Nipple confusion does not exist. Krista stopped breastfeeding at 6 months, but her baby could not tolerate formula. She is requesting your help restarting breastfeeding. What is your FIRST suggestion? A) We can talk to your doctor about prescribing medications to resume milk production B) Start by putting your baby close to your breast, skin to skin, several times a day to see how he responds C) Pump with a hospital grade breast pump with a double collection kit at least 8 times a day D) It is too late now, once you start breastfeeding you cannot resume B) Start by putting your baby close to your breast, skin to skin, several times a day to see how he responds Kelly's baby was born with a cleft lip. This is her second baby and she has breastfed her first baby. She asks you for help breastfeeding. What should be your FIRST action in helping this baby breastfeed? A) Help the mother position baby deeply at the breast so her breast fills the baby's cleft B) Help the mother hand express her milk to feed with an open cup C) Provide a breast pump with a double collection kit until the baby can latch D) Give the mother a silicone nipple shield to create a negative pressure in baby's mouth A) Help the mother position baby deeply at the breast so her breast fills the baby's cleft BREASTFEEDING IS ALWAYS THE FIRST CHOICE In regards to late preterm infants, what should he counselor be observing during a breastfeeding session? Mothers position Latch Milk transfer Potential complications: Hypoglycemia, hyperbilirubinemia, and weight loss Management strategies to help a hypotonic infant avoid choking Use a sling or pillows to support the infant in a flexed position. Support the breast and infants jaw. "Dancer hand" Hand expression and breastfeeding at the same time Nipple shields or nursing supplementer Behaviors that preterm infants may exhibit to suggest they are NOT ready for oral feeds Difficulty breathing Color change Coughing/choking Tachypnea Spitting up Hypertonicity/flaccidity Irritability Gaze aversion If a preterm baby is not able to nurse, when should the counselor recommend that a mother begin pumping? As soon as possible and ideally within the first 1-2 hours after birth What are some position modifications that can be made to help infants effectively breastfeed with cleft lip/palate? Cross cradle modified football Dancer hand Infant should be semi-upright to reduce nasal regurgitation and reflux of breastmilk into the eustachian tubes What topics should you include when you are discussing lactation with a woman who is planning to adopt? The opportunities and challenges involved in induced lactation or re-lactation Hormone supplementation The need for manual or electronic stimulation of the breast on a consistent schedule several times a day (at least two months prior to delivery) The necessity of the newborn suckling at the breast to stimulate milk production and develop feeding patterns Potential need for supplementation Use of supplemental feeding aids Risk and benefits of pharmaceutical and herbal galactagogue supplementation List some management strategies when working with a mother of multiples Create a feeding rotation (different breast each feed/every 24 hours) Individual vs. simultaneous feedings Partial breastfeeding Appropriate follow up Kelsey had a breast reduction when she was 20 years old. Now that she has a baby she may need to use: A) A breast pump to relieve engorgement B) A nipple shield to enhance nipple stimulation C) A feeding tube system because of lactation insufficiency D) Breast shells to enhance nipple eversion C) A feeding tube system because of lactation insufficiency You are assisting Christine, a mother of a late preterm infant, to latch to the breast. Christine is making sufficient milk with pump support, but the baby cannot latch and maintain feeding for more than a few moments before slipping off the breast. What should be your NEXT action? A) Tel mom that direct breastfeeding is too tiring for the infant and give her a bottle B) Urge her to continue to pump until the baby is ready for breastfeeding, approximately around her original due date C) Suggest using a thin silicone nipple shield to keep the nipple extended in the baby's mouth during feeds D) Help her use a tube-feeding device to provide extra breastmilk at the breast C) Suggest using a thin silicone nipple shield to keep the nipple extended in the baby's mouth during feeds The shield will compensate for the infants weak suck and has been shown to lengthen the duration of breastfeeding. Which pumping strategy is MOST LIKELY to maximize amount of milk collected? A) Pump at the lowest comfortable pressure B) Cycle the pump slowly at first, then faster as milk flows C) Choose a flange diameter that fits the nipple snugly D) Hands on pumping D) Hands on pumping Once lactogensis 2 has occurred, mothers usually get the most milk during pumping if they A) Pump at its preset minimum suction level thought the pumping session B) Raise the suction level to the pumps maximum when MER occurs C) Raise suction level to mothers own maximum comfort level when MER occurs D) Gradually increase suction level little by little through the pumping session C) Raise suction level to mothers own maximum comfort level when MER occurs What are the considerations in breast pump selection? How often pumping will be needed If baby is breastfeeding or not If mom is building supply or maintaing Where will pumping occur What are some uses for breast shells? To evert flat or inverted nipples either prenatally or postpartum Collect leaking milk Relieve engorgement Protect painful, tender nipples What are three situations in which a nipple shield might be useful? If the infant is unable to latch due to flat or inverted nipples The baby is unable to draw the nipple/areola into his mouth Mom has an overactive let down or oversupply where baby has a hard time dealing with the flow Moms nipples are sore, damaged, or infected Infant has a weak, disorganized suck Nipple confusion/breast refusal Cleft palate, Pierre-Robin, or a short frenulum What are the advantages and disadvantages of the alternative feeding methods? It provides supplementary feeding while still allowing the infant to work on their suck reflux and avoid nipple preference What are some uses for the Haberman feeder? Used in severe feeding problems such as: Downs syndrome, cleft lip/palate, neurological dysfunction, disorganized sucking, cardiac defects, cystic fibrosis and preterm infants June is breastfeeding and has been diagnosed with postpartum depression. Her physician discusses with you about whether or not she should continue during breastfeeding treatment. Your BEST response is: A) Several different antidepressants are considered compatible with breastfeeding B) All medications used to treat mental illness are contraindicated in breastfeeding C) Her baby is in great danger and should be kept away from her D) The hormones in breastfeeding will exacerbate her illness A) Several different antidepressants are considered compatible with breastfeeding Which drug decreases rapidly in breastmilk after the mother stops taking the drug? A) Marijuana B) Cocaine C) Amphetamines D) Alcohol D) Alcohol Natalie received intravenous magnesium sulfate during labor to control her blood pressure and is having trouble initiating breastfeeding. The MOST LIKELY explanation for this is: A) This medication can cause maternal lethargy, confusion and muscle relaxation B) The medication affected the baby's ability to suck C) Her milk tastes unpleasant because of the medication D) The drug reduced the amount of colostrum available, the baby is frustrated A) This medication can cause maternal lethargy, confusion and muscle relaxation What are some considerations when discussing medication and breastfeeding? Determine the need, avoid the use of any non-essential medications Risk vs. benefit Choose drugs that don't pass into milk Use lowest dose possible Avoid breastfeeding at peak medication times Make sure the prescribing doctor knows mom is breastfeeding What should the counselor be looking for when assessing the infants responses to medication? Behavioral changes: alertness, neuromuscular irritability or flaccidity, sleep patterns GI changes: diarrhea and constipation Skin rash What are two categories of medication that are contraindicated with lactation? Antimetabolite Chemotherapeutic Active radioisotopes Illicit substance use When should Depo-Provera for birth control be administered? After lactation is fully established, approximately 6 weeks postpartum What birth control method is compatible with breastfeeding? All of them Progesterone containing contraceptives may cause a slight decrease in milk supply Estrogen containing medications are not ideal for early postpartum mothers as estrogen can cause milk suppression