ALPP CLC EXAM 2025 CERTIFIED LACTATION COUNSELOR REAL/AUTHENTIC PROCTORED EXAM QUESTIONS AND VERIFIED ANSWERS

ALPP CLC EXAM 2025 CERTIFIED LACTATION COUNSELOR REAL/AUTHENTIC PROCTORED EXAM QUESTIONS AND VERIFIED ANSWERS “breast feeding: a public health priority - CORRECT ANSWER has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US" "the code - CORRECT ANSWER regulates the marketing of breastmilk substitutes which includes infant formulas, follow-on formulas, and any other food or drink, together with feeding bottles and teats, intended for babies and young children; sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries" "restricting marketing - CORRECT ANSWER does not mean that the products cannot be made available, neither does it restrict parents choice; it simply aims to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims" "the strategy - CORRECT ANSWER is intended as a guide for action - it identifies interventions with a proven positive impact - it emphasizes providing mothers and families the support they need to carry out their crucial roles - it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties" "the world breastfeeding trends initiative - CORRECT ANSWER intended to track, assess, and monitor the implementation of the "global strategy" at the country and sub-country level" "what contributes to low rates of ebf globally? - CORRECT ANSWER - caregiver and societal beliefs favoring mixed feeding -hospital and healthcare practices and policies that are not supportive of BF - lack of adequate skills and support - aggressive promotion of infant formula and other breastmilk substitutes - inadequate maternity/paternity leave legislation - workplace policies - lack of knowledge about dangers of not exclusively BF and proper BF techniques" "how to support ebf - CORRECT ANSWER increase hospital and health system capacity regarding baby friendly hospital initiative -provide community based strategies including campaigns tailored to local context -strengthen monitoring and enforcement of the code -enact at least 6 months paid maternity leave -invest in training and capacity building in protection, promotion, support" "disparity of US breastfeeding trends - CORRECT ANSWER according to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents"" "anatomy of milk cells - CORRECT ANSWER myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells" "anatomy of human breast - CORRECT ANSWER glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings" "preterm milk - CORRECT ANSWER appears to have a different composition for the first 5-7 weeks after delivery independent of gestational age at delivery - appears to be higher in protein, fat, and electrolytes than term milk - if baby is SGA, LGA, or AGA, does not make a difference in milk composition" "after 1 year of lactation - CORRECT ANSWER has significantly increased fat and energy contents" "fore vs hind milk - CORRECT ANSWER foremilk is milk at the beginning of a feed, hindmilk is at the end of a feed - used to think that hindmilk contained more fat content but it is more complex than originally described - foremilk does not mean "low fat" and hindmilk is not always highest in fat - sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk" "breastmilk composition changes - CORRECT ANSWER - over the course of lactation - within the day - within a feeding - between feedings is also changes by the way it is taken" "babyled feeding - CORRECT ANSWER "the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding"" "maximum fat levels - CORRECT ANSWER obtained 30 mins post-feed - mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants" "milk composition, milk action - CORRECT ANSWER milk composition is complex, milk action is redundant - milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements" "less diarrhea - CORRECT ANSWER most readily acknowledged advantage od breastfeeding, ebf makes the biggest difference in rates and severity - 86% of diarrhea-associated infant deaths occurred among LBW infants - if breastfed baby does get diarrhea, keeping breastfeeding makes a difference in maintaining the microbiota" "mechanisms by which ebf protects from diarrhea - CORRECT ANSWER 1. ph of gut 2. low iron in gut 3. presence of bifidus factor 4. presence of hormones 5. antibodies such as SIgA 6. white blood cells 7. cell wall disrupters 8. B12 binding factor 9. lactoferrin 10. antimicrobial activity boosters 11. mucosal wall protectors 12. microbes 13. absence of exposure to contaminants 14. antibodies 15. synergistic effect" "what increases gastrin and decreases somatostatin in babies? - CORRECT ANSWER - sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation - species own milk - decreased stress - touch - wellness" "adult GI hormones - CORRECT ANSWER also impacted by suckling when mother suckles her gastrin and cholecystokinin go up. this increases the efficacy of insulin and increases the storage of ingested nutrients" "stress & hormones - CORRECT ANSWER stress + male hormones = fight or flight stress + oxytocin + female hormones = tend and befriend" "postpartum post traumatic stress disorder (PP-PTSD) - CORRECT ANSWER up to 9% of PP women met the DSM-5 criteria for PTSD after childbirth" "two conditions that increase odds of PP-PTSD - CORRECT ANSWER - depressive symptom scores - total number of physical symptoms experienced since birth" "MYTH - its about the types or amounts of foods eaten during laction - CORRECT ANSWER humans have breastfed and are breastfeeding under conditions we can't even imagine. this is possible because: - lactation has a lower energy cost for humans compared to other mammals - number of kcal/day for lactation is much less than previously believed - the body adapts with physiological mechanisms in favor of lactation in humans" "when the infant suckles from the breast... - CORRECT ANSWER there is an outpouring of 19 different GI hormones in both the mother and the infant, including cholecystokinin, which cycles to the kidneys, and gastrin, which stimulates growth of the baby and mother's villi, increasing surface area and absorption of calories with each feeding" "Cherie, a new mother, with a 4-week-old infant, visits you for a breastfeeding evaluation. In the process of taking her history, you find that Cherie eats mostly chips, cookies and soda "because she is just too busy to prepare anything". Your MOST IMPORTANT concern with Cherie's diet is: a) The quality of her breast milk b) The quantity of her breast milk c) The health of the baby d) The depletion of Cherie's nutrient stores - CORRECT ANSWER d) The depletion of Cherie's nutrient stores" "Halli is now 2-hours-old and still has not shown any interest in nursing. You do a blood sugar test on Halli, and find that it's 38 mg/dL, which is lower than your hospital standard of 40 mg/dL. What should you do first? a) Put her under the warmer as she is most likely hypothermic b) Give her 1 oz. of formula by finger-feeding c) Have mom hand express colostrum and feed her with a spoon d) Wait about 30 seconds and use a second reagent strip to check the glucose - CORRECT ANSWER d) Wait about 30 seconds and use a second reagent strip to check the glucose" "Mothers with breastfeeding problems may be hesitant to seek help from a professional for the following reason: a) Lack of insurance coverage for lactation services b) Having to leave her home to seek help c) Stress of having to repeat "her story" to multiple people d) Having problems is in conflict with the image of being a super-mom, which she wants to portray - CORRECT ANSWER d) Having problems is in conflict with the image of being a super-mom, which she wants to portray" "A type of research that focuses on relationships among variables is called: a) Qualitative b) Quantitative c) Statistically significant d) Randomized controlled trials - CORRECT ANSWER b) Quantitative" "Nipple erection is induced by which of the following? a) Myoepithelial cells contracting the lactiferous sinuses b) Somatic parasympathetic stimuli c) Autonomic sympathetic stimuli d) Adequate levels of aphrodisiacs - CORRECT ANSWER b) Somatic parasympathetic stimuli" "Which of the following drug categories are contraindicated for use during breastfeeding? a) Pseudoephedrine b) Oral contraceptives c) Cancer chemotherapeutic agents d) Diuretics - CORRECT ANSWER c) Cancer chemotherapeutic agents" "You are a nurse who works at St. Beneficial Hospital. You have just delivered preterm twins. A formula representative offers you samples of a new formula, which provides specific nutrients for your low birth weight infants. In what way is this a violation of the International Code of the Marketing of Breast-Milk Substitutes (WHO Code)? a) This isn't a violation as the WHO Code provides for samples of specialized formulas for low birth weight babies b) The WHO Code states that no personal samples of formula may be given to health care workers c) As an employee of a not-for-profit hospital, you cannot accept gifts from formula companies d) This isn't a violation because you are unable to breastfeed your twins, so accepting formula isn't an issue - CORRECT ANSWER b) The WHO Code states that no personal samples of formula may be given to health care workers" "Month-old Reuben weighed 7 lbs., 2 oz. at birth. When you weigh him, he is 7 lbs., 4 oz. Helen-Clare says Reuben nurses all the time and never seems satisfied. When you do ac/pc weights, he transfers a total of 37 mL. When Helen-Clare pumps for residual milk, she gets an additional 3 mL. Which suggestion will you make first? a) You need to make sure the feedings are finished within 45 minutes so both of you can get rest b) Reuben needs a supplement, which will provide him with additional calories c) You need to use a nursing supplementer to give Reuben the extra calories he needs and provide some breast stimulation at the same time d) To increase your milk supply, you are going to need to pump with a quality breast pump and take some galactogogues - CORRECT ANSWER b) Reuben needs a supplement, which will provide him with additional calories" "Infants who have a higher than average number of bowel movements during the first 3 DOL will probably exhibit which of the following: a) Dehydration as evidenced by poor skin turgor b) Later transition to yellow stools c) Higher bilirubin levels on day 5 d) Weight loss greater than 10% on day 4 - CORRECT ANSWER d) Weight loss greater than 10% on day 4" "Susan has nipples that are raw and bleeding from nursing her infant who was tongue tied, but who had it revised yesterday. Which of the following would be a good first choice to use with her nipple trauma? a) Tea bags b) Coconut oil c) Saline soaks d) Antibiotic ointment - CORRECT ANSWER c) Coconut oil" "Milk banks who are members of the Human Milk Banking Association of North America: a) Provide milk to both hospitals and individuals b) Allow selected donors to be paid c) Test donor milk for bacteria d) Sell the milk for a substantial profit - CORRECT ANSWER a) Provide milk to both hospitals and individuals" "Infants may suddenly collapse while doing skin-to-skin. What can be done to decrease the risk of this happening? a) Mother lying flat with the baby between her breasts b) The baby's head is turned to one side, and is very slightly extended c) Head tilted back so trachea is straight and extremities extended d) Infant's chest is in contact with the mother's body and head is midline - CORRECT ANSWER b) The baby's head is turned to one side, and is very slightly extended" "When a hospital who was working to become Baby Friendly eliminated pacifier use, what was the outcome? a) Supplemental formula increased from 18-28% b) Breastfeeding challenges decreased by a factor of 10 c) Exclusive breastfeeding rates increased from 68-79% d) 15% of mothers were sneaking pacifiers into the facility - CORRECT ANSWER a) Supplemental formula increased from 18-28%" "The optimal time interval between pregnancies for a mother is: a) 6-9 months b) 12-15 months c) 24-30 months d) 36-59 months - CORRECT ANSWER d) 36-59 months" "Rebecca tells you that Tanya, her 3-week-old breastfed infant, has colic. You know that the most common reason for "colic" is: a) Infant isn't being fed enough b) Mother is smoking more than 1/3 pack of cigarettes per day c) Mother has too much breast milk d) A diet that is very high in dairy products - CORRECT ANSWER a) Infant isn't being fed enough" "Stacey visits you stating her "milk hasn't come in yet". Her baby is 10-days-old and hasn't regained her birth weight. After taking a history, you discover that Stacey continues to have heavy bleeding that contains blood clots. What do you suspect is the reason for the low milk supply? a) Retained placental fragments causing a decrease in prolactin levels b) Retained placental fragments causing estrogen levels to remain high c) Retained placental fragments causing progesterone levels to remain high d) Retained placental fragments causing a drop in the prolactin inhibitory factor (PIF) - CORRECT ANSWER c) Retained placental fragments causing progesterone levels to remain high" "Which of the following statements about prolactin is true? - CORRECT ANSWER Prolactin causes milk to be made" "Which of the following mechanisms cause oxytocin to be released? - CORRECT ANSWER Nipple stretching with appropriate latch-on" "Lactogenesis III requires which of the following to succeed? - CORRECT ANSWER Frequent milk removal and nipple stimulation" "The fat of milk suckled by the baby is determined by: - CORRECT ANSWER The speed/efficiency with which the baby removes milk" "Which of the following is the most effective at increasing a gastric and CCK and decreasing somatostatin in the baby - CORRECT ANSWER Feeding with species-specific milk" "Studies on childhood obesity demonstrates that: - CORRECT ANSWER There is an inverse relationship between duration and obesity prevalence in a large population" "When undernourished mothers were supplemented with extra in their diet, they: - CORRECT ANSWER Responded to their infants more appropriately" "Carbohydrates found only in mammal milk? - CORRECT ANSWER Lactose" "Cholecystokinin (CCK) helps babies feel a sense of - CORRECT ANSWER Satiety" "Not enough water, too much stress, don't exercise - CORRECT ANSWER Myths" "Not necessarily lower infant content - CORRECT ANSWER Foremilk" "Gland that secretes lactation hormones - CORRECT ANSWER Pituitary" "A cluster of milk-making cells - CORRECT ANSWER Alveolus" "Stage II, it begins with the delivery of the placenta - CORRECT ANSWER Lactogenesis" "Newborn milk - CORRECT ANSWER Colostrum" "Human milk is composed of almost 88% - CORRECT ANSWER Water" "Hormone responsible for milk ejection - CORRECT ANSWER Oxytocin" "Breast milk is low int his nutrient but it is almost all bioavailable - CORRECT ANSWER Iron" "Nerves that innervate the breast - CORRECT ANSWER Thorastic" "The number one concern moms stop breast feeding is - CORRECT ANSWER Low milk production" "Hormone that increases with frequent nipple stimulation - CORRECT ANSWER Prolactin" "Hormone secreted by the placenta - CORRECT ANSWER Progesterone" "Promotes the release of gastrin - CORRECT ANSWER Touch" "A leading cause of infant death globally - CORRECT ANSWER Diarrhea" "Best practice is guided by the highest available level of - CORRECT ANSWER Evidence" "Example of protection - CORRECT ANSWER State law on breastfeeding in public" "Examples of promotion - CORRECT ANSWER Breastfeeding cost less" "Example of support - CORRECT ANSWER La leche League Leader" "International cod of marketing - CORRECT ANSWER Restricts formula marketing practices" "Montgomery glands - CORRECT ANSWER Secrete lubricating fluid on areola" "Elevated prolactin levels close it - CORRECT ANSWER Paracellular pathway" "Cochran's collaborations - CORRECT ANSWER Conducts systematic reviews" "Lactiferous sinus - CORRECT ANSWER Not actually there, when hey added wax to find" "Cholecystokinin (CCK) - CORRECT ANSWER GI hormone that causes fullness/sedation" "Colostrum - CORRECT ANSWER Produced by hormones of pregnancy" "exclusive breastfeeding - CORRECT ANSWER No food or drink other than human milk" "Storing energy for growth - CORRECT ANSWER Anabolism" "Hindmilk - CORRECT ANSWER The last part of feeding" "Muscles cells around the alveolus - CORRECT ANSWER Myoepithelial cells" "Inter bout interval - CORRECT ANSWER Period when baby is not at breast" "Receptor site - CORRECT ANSWER Cellular "lock" for a chemical "key"" "Baby hand massage - CORRECT ANSWER Oxytocin releasing mechanism" "Hyperinsulinemia - CORRECT ANSWER Associated with obesity in formula-fed infants" "Abscess - CORRECT ANSWER A pocket of debris (pus) within the body containing broken down blood cells and antibodies. Typically follows an infection, and causes local swelling and inflammation" "Adipocytes - CORRECT ANSWER Fat cells" "Adrenaline - CORRECT ANSWER A corticosteroid hormone responsible for the "fight or flight" response" "AGA - CORRECT ANSWER Appropriate for gestational age" "Albumin - CORRECT ANSWER A form of protein found in the body" "Alveoli - CORRECT ANSWER Small glands in the breast that produce breast milk" "Amenorrhea - CORRECT ANSWER Absence of menstrual cycle" "Anemia - CORRECT ANSWER A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume" "The FDA reports that - CORRECT ANSWER There is no consistent pattern of who does and does not make formula safely" "Which of the following does not reduce the storage capacity of the breast - CORRECT ANSWER Amount of tea mom drinks" "With Sheehan;s Syndrome - CORRECT ANSWER Pituitary function may be impaired permanently" "Wendy is a WIC nutritionist who teaches a three hour., comprehensive breastfeeding class. Which groups of "knowers" may have the most difficulty with Wendy's class? - CORRECT ANSWER Women in silence" "One of the reasons why women in developed have higher breast cancer reates than women in developing countries is because - CORRECT ANSWER They breastfeed for shorter durations" "Dr. Gerd is a pediatric gastroenterologist who conducts research on reflux. His practice reflective studies that show that: - CORRECT ANSWER Cow milk allergy is associated with about 50% of cases of reflux" "Formula contamination with organisms is - CORRECT ANSWER A greater problem with power than liquid" "Babies who are formula fed are more likely to have which of the following outcomes - CORRECT ANSWER Higher rates of SIDS" "What is the most effective storage in breastfeeding counseling - CORRECT ANSWER Listening" "Susie is 2 days old and she is not living up to her name. What is one possible reason for her incorrect/unsuccessful breastfeeding - CORRECT ANSWER A 2 hour delay in initiating feeding" "An optimal state for breastfeeding is when the baby is - CORRECT ANSWER REM sleep" "One of the advantages of having babies room-in with their mother is that - CORRECT ANSWER Mothers can feed when feeding cues are given" "Helping a mother to learn about correctly latching the baby on involves - CORRECT ANSWER Observing of pre-feeding and readiness behaviors" "When latching the baby to the breast - CORRECT ANSWER Start with the baby's nose at the level of the nipple" "Which of the following is an advantage of being skin-to-skin. For the infant - CORRECT ANSWER Babies cry less" "Pregnant women choose formula because they - CORRECT ANSWER Feel more comfortable with the idea of formula feeding" "Smell is - CORRECT ANSWER A sense that helps guides babies to the breast" "Studies about mothers hospital experience indicate that of mother who intended to breastfeed - CORRECT ANSWER The mejor of them reported that they were given formula packs at discharges" "When a supplement has been ordered, which of the following is most important when considering using an at-breast supplementer - CORRECT ANSWER Whether the baby is able to be a positioned and transfer adequately at the breast" "One plausible suggestion that might help a mother to increase the volume of milk is to - CORRECT ANSWER Use two flanges and pump both breasts at the same time" "Raynaud's and of the nipple is characterized by - CORRECT ANSWER Blanching of the nipple" "The best advice for a mother suffering from mastitis is to - CORRECT ANSWER Keep breastfeeding frequently on both sides" "Which of the following has been found to be a significant risk factor for mastitis - CORRECT ANSWER Hurreid, infrequent feedings" "The 2010 health care reforms act - CORRECT ANSWER Providers for time for milk expression during the work day" "Peggy poop is 4 months old and exclusively breastfed. She has been having visible blood in her stools. What is the most likely breastfeeding related reason for this bloos - CORRECT ANSWER Cow milk protein in the mothers diet" "Alcohol consumption by the mother may results in: - CORRECT ANSWER Lower milk consumptions by the baby after the alcohol is consumed" "Which of the following is NOT a questions that is important to the success of the lactational amenorrhea method (LAM) - CORRECT ANSWER Adequate nutrition of the mother" "Environmental contaminants in breast milk are - CORRECT ANSWER Minimal compared to uterine exposure" "May cause colic is some babies - CORRECT ANSWER Whey" "Bringing back a milk lactation - CORRECT ANSWER Relactation" "Metabolic disorder of the baby which makes breast milk contraindicated - CORRECT ANSWER Galactosemia" "Itchy flaky reddened breast and nipple may be - CORRECT ANSWER Candida" "Pimple like block of a nipple sore - CORRECT ANSWER Bleb" "Only contractecptives are ok for breastfeeding after 6 weeks - CORRECT ANSWER Progesterone" "Can cause lesion, mastitis adn abscess - CORRECT ANSWER MRSA" "Area of pus which needs to be drained - CORRECT ANSWER Abscess" "Affects up to 20% of postpartum women - CORRECT ANSWER Anemia" "When women use these they are at a higher risk of weaning early - CORRECT ANSWER Shields" "These knowers seek information from a variety of resoruces - CORRECT ANSWER Procedural" "These knowers like to be be helped by someone who is similar - CORRECT ANSWER Subjective" "In lactogenesis III what can reduce supply? - CORRECT ANSWER Pressure" "It is best to use few words with these people - CORRECT ANSWER Women in silence" ""Final Rule" on formula spring 2014 - CORRECT ANSWER FDA" "May be prevented or delayed with longer duration of breastfeeding - CORRECT ANSWER Diabetes" "Can result in Sheehan's syndrome - CORRECT ANSWER Hemorrhage" "May be indicator of sore nipples - CORRECT ANSWER Pacifiers" "May cause lower rise of prolactin - CORRECT ANSWER Smoking" "Late stage of hunger - CORRECT ANSWER Crying" What duration of breastfeeding is associated with significantly reduced incidence of acute otits media (AOM)? A) Any breastfeeding B) Up to 3 mos C) More than 4-6 months - CORRECT ANSWER C) More than 4-6 months" "Breastfeeding lowers the risk for the incidence of dental caries compared to children fed nonhuman milk from a bottle. True of False? - CORRECT ANSWER True" "Does breastfeeding lower the risk of NEC in preterm infants? - CORRECT ANSWER Yes" "Is there a difference in the protective effect against SIDS between babies that are exclusively breastfed vs. non-exclusively? - CORRECT ANSWER Yes, babies that are exclusively breastfed have a stronger protective effect against SIDS" "Does breastfeeding lower the risk for the incidence of malocclusion (misalignment of teeth)? - CORRECT ANSWER Yes" "True of False. Lactational amenorrhea, or the delay in return of menses after birth, is not associated with exclusive breastfeeding. - CORRECT ANSWER False" "What are the physical benefits of breastfeeding to the lactating parent? - CORRECT ANSWER Lower risk of breast cancer, lower risk of ovarian cancer, reduced risk of Type 2 diabetes, reduced risk of cardiovascular disease" "What are the 3 main steps of Evidence-Based Practice (EBP)? - CORRECT ANSWER Best available clinical evidence, Clinical expertise, Patient concerns and needs" "What are the benefits of breastfeeding for infants? - CORRECT ANSWER Protective against respiratory infections, asthma, gastrointestinal infections and diarrhea, ear infections, dental caries, teeth misalignment, NEC and SIDS, obesity, diabetes, higher performance on intelligence tests" "What are hypotonic lips in an infant? - CORRECT ANSWER Abnormally LOW muscle tone or weakness in lips- may impact amount of suction, increase work of feeding, can contribute to milk loss and fatigue during feedings" "What are hypertonic lips in an infant? - CORRECT ANSWER Abnormally HIGH muscle tone or overuse of lips- increased lip activity to hold breast in mouth" "What can hypertonic lips be an indication of? - CORRECT ANSWER 1. Neurological abnormality or injury of the tongue, jaws, or facial nerves. 2. Can also be compensating for muscular weakness in the cheeks, jaw, or tongue or reduced lingual or labial mobility secondary to a tight labial frenulum or ankyloglossia (tongue-tie) 3. May be sensory in nature (hypo- or hypersensitive)" "What is a tethered maxillary frenulum? - CORRECT ANSWER Referred to as upper or superior labial frenulum- a tightness or thickness in the band of tissue that attaches the upper lip to the upper gum" "What is a cleft lip? - CORRECT ANSWER A fissure or opening in the upper lip, may extend into the nose, may be unilateral or bilateral" "What is the second most common birth defect? - CORRECT ANSWER Cleft lip" "What is a sign of a possible tight maxillary frenulum? - CORRECT ANSWER Blanching of the frenulum when gently lifting the upper lip, reduced lip movement" "What may cause sucking blisters? - CORRECT ANSWER Friction from retracted lips, a tight maxillary frenulum restricting upper lip mobility, can be secondary cause of tight lingual frenulum (tongue-tie) or hypertonia" "When observing a feeding, what signs can indicate an issue with the infant's lips? - CORRECT ANSWER Breaks in the seal with the breast, lip retraction and lip tremors, leaking milk" "What are 2 ways to help improve tone and strengthen the lip seal for infants with abnormal lip tone? - CORRECT ANSWER 1. Provide firm pressure stimulus (i.e. tapping) on the lips prior to feeding. 2. Insert clean finger or round, somewhat firm pacifier, then partially pull it out of infant's mouth to induce the infant to pull it back." "How can parents help infant with cleft lip breastfeed? - CORRECT ANSWER By using finger or shape of the breast tissue to seal the cleft." "What are buccal pads? - CORRECT ANSWER Subcutaneous fat deposits in cheeks" "What can cause low facial tone or poorly developed buccal pads in an infant? - CORRECT ANSWER Prematurity or low birth weight" "What are possible issues due to facial hypotonia? - CORRECT ANSWER Decreased cheek stability hindering seal on the breast, infant needs to create a greater vacuum to generate and sustain suction, this increases the work of feeding and can cause fatigue before feeding is complete." "How do you assess cheeks on an infant? - CORRECT ANSWER Place a gloved finger inside infant's mouth and place a thumb on the outside of the cheek to sense the thickness of the fat pads. With thin cheeks, finger and thumb almost touch." "How can you identify weak, thin, or unstable cheeks during a feed? - CORRECT ANSWER Cheeks will collapse while baby sucks. Also look for dimples." "What method can be used to assist an infant with low facial muscle tone during feeds? - CORRECT ANSWER Dancer hold- provide external support during feeding by using fingers and hand to support infant's jaw and cheeks" "What is micrognathia? - CORRECT ANSWER Abnormally small lower jaw" "What is retrognathia? - CORRECT ANSWER Abnormally receding lower jaw" "What can severe micrognathia (abnormal small lower jaw) and retrognathia (abnormally receding lower jaw) be signs of? - CORRECT ANSWER Pierre Robin sequence" "What can infant jaw clenching during feeding be a sign of? - CORRECT ANSWER Hypertonia or a weakness in a different area (e.g. poor tongue or lip function)" "What do you look for when assessing an infant's jaws? - CORRECT ANSWER Observe for asymmetry, Identify micrognathia or retrognathia, Identify jaw grading, clenching, or tremors during feeding" "How do you do an oral assessment of an infant's jaw? - CORRECT ANSWER Insert gloved pinkie finger in corner of infant's mouth between posterior gum pads: 1. Count number of reflexive bites (chews) 2. Infant should respond with 10 chews per side 3. Observe difficulty producing reflexive bites or stress cues during assessment" "What are 2 things that can be done to assist an infant while feeding to assist with jaw issues? - CORRECT ANSWER 1. Provide external jaw support with a finger placed under bony part of lower jaw to control/stabilize distance of jaw excursions 2. Identify feeding positions that emphasize postural stability (hip flexion, stabilize trunk) and maintain head extension to bring lower jaw closer to breast" "What methods can be done to improve results of infant feeding issues due to jaw abnormalities, weakness, or injury? - CORRECT ANSWER 1. Exercise jaws several times a day 2. Refer infant for physical therapy or body work 3. Refer infant for speech or occupational therapy for assessment for feeding difficulties" "costs to prevent needless deaths - CORRECT ANSWER less than $6 billion/year worldwide" "suboptimal breastfeeding - CORRECT ANSWER accounts for more than 3,340 maternal and child deaths a year, 80% are maternal" "nursing a baby for a year or more - CORRECT ANSWER decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease" "women who do not breastfeed - CORRECT ANSWER are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer" "WHO and UNICEF three strategies - CORRECT ANSWER for increased breastfeeding initiation and duration in every country: promotion, protection, and support" "breastfeeding promotion - CORRECT ANSWER focuses on advantages of breastfeeding on a personal, community, country, or global level" "breastfeeding protection - CORRECT ANSWER focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc." "breastfeeding support - CORRECT ANSWER focuses on the interaction of "helpers" with family as well as program development and implementation" "community expertise - CORRECT ANSWER variety of community expertise is needed to promote, protect, and support breastfeeding" "International models - CORRECT ANSWER for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols" "CLC - CORRECT ANSWER nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified" "CLCs and IBCLCs - CORRECT ANSWER health professionals who provide lactation support" "why is breastfeeding so difficult? - CORRECT ANSWER 1. unrealistic expectations 2. lack of timely interventions" "unrealistic expectations - CORRECT ANSWER lack of preparation for what the newborn period would look like" "lack of timely interventions - CORRECT ANSWER mother's problems at 3 to 7 days posed as the greatest risk to stopping" "breastfeeding trends - CORRECT ANSWER last 150 years or som rates have declined" "international code of matketing of breastmilk substitutes (the code) - CORRECT ANSWER an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding - published by the WHO in 1981 - internationally agreed voluntary code of practice - written in response to the marketing activities of the infant feeding indurstry which were promoting formula feeding over breastfeeding, which in turn was leading to dramatic increases in maternal and infant morbidity and mortality - subsequent clarifying and extending resolutions have been passed by the world health assembly" "making milk - CORRECT ANSWER messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system" "hormone pathways - CORRECT ANSWER two separate hormone pathways, pituitary gland is important to both" "prolactin levels - CORRECT ANSWER go down in between nursing and rise during nursing" "infrequent nursing - CORRECT ANSWER leads to lower levels and less rise even with the same amount of nipple contact" "ongoing milk production - CORRECT ANSWER positively associated with suckling within the first 2 hours after birth" "initiation for mothers of preemies - CORRECT ANSWER initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42" "triggering oxytocin mechanism #1 - CORRECT ANSWER conditioned response - conditioned milk ejection (let down) reflex - was probably given too much importance in the years we didn't understand the other mechanisms - conditioned over time and lasts a lifetime - is faster for women who already have one from previous breastfeeding - to condition response.. smell, touch, hear the stimulus" "triggering oxytocin mechanism #2 - CORRECT ANSWER nipple stretching, happens with a proper latch" "triggering oxytocin mechanism #3 - CORRECT ANSWER baby hand massage, each hand movement releases oxytocin" "hormones of lactation - CORRECT ANSWER have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust" "milk composition - CORRECT ANSWER is complex - each species of mammal milk is different - milk is "species specific"" "nest or cache - CORRECT ANSWER mammal species with high fat/protein and low water content = infrequent feeds nest = bunnies cache = deer" "carry, follow, or hibernate - CORRECT ANSWER mammal species with hither water content milk have more frequent feeds carry = koala follow = elephants hibernate = bears" "our culture - CORRECT ANSWER wants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers" "the brain - CORRECT ANSWER most rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth" "nursing pattern - CORRECT ANSWER should be frequent to accommodate human milk composition" "stages of making human milk - CORRECT ANSWER lactogenesis I, lactogenesis II, lactogenesis III" "lactogenesis I - CORRECT ANSWER secretory differentiation, placental hormones, colostrum" "lactogenesis II - CORRECT ANSWER secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk" "lactogenesis III - CORRECT ANSWER lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk" "breastmilk composition - CORRECT ANSWER human milk changes continually, makes it impossible to obtain a single representative sample of milk" "diarrhea mechanisms 1 - ph of the gut - CORRECT ANSWER breastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies" "diarrhea mechanisms 2 - low iron in the gut - CORRECT ANSWER relatively low iron content in human milk" "diarrhea mechanisms 3 - presence of bifidus factor - CORRECT ANSWER promotes intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms" "diarrhea mechanisms 4 - presence of hormones - CORRECT ANSWER hormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as: - GI hormones - prolactin - EGF (epidermal growth factor) - prostaglandins" "diarrhea mechanisms 5 - antibodies - CORRECT ANSWER such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. mother's IgA has been found to protect against the development of NEC in preterm infants. maternal IgA shapes the host-microbiota relationship of pretern neonates that IgA in maternal milk is critical and necessary factor for the prevention of NEC" "diarrhea mechanisms 6 - white blood cells - CORRECT ANSWER kill microbes directly or mobilize other defenses" "diarrhea mechanisms 7 - cell wall disrupters - CORRECT ANSWER kill microbes by destroying the cell walls, these include fatty acids and lysozymes" "diarrhea mechanisms 8 - B12 binding factor - CORRECT ANSWER reduces the amount of B12 in the intestines available to microbes" "diarrhea mechanisms 9 - lactoferrin - CORRECT ANSWER deprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms" "diarrhea mechanisms 10 - antimicrobial activity boosters - CORRECT ANSWER such as fibronectin and gamma interferon" "diarrhea mechanisms 11 - mucosal wall protectors - CORRECT ANSWER such as mucins and oligosaccharides, which also function as food for beneficial bacteria, adhere to microbes binding them so that they can't attach to the gut wall" "diarrhea mechanisms 12 - microbes - CORRECT ANSWER from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring" "diarrhea mechanisms 13 - contaminants - CORRECT ANSWER absence of contaminants (bottles, teats, water) and formula ingredients" "diarrhea mechanisms 14 - antibodies - CORRECT ANSWER a. when a mother is exposed to organisms she makes antibodies and secretes them into her milk b. another way baby is protected - cells go from the baby's mouth into the breast and antibodies are made in the breast the process of breastfeeding has effects beyond the components of the milk. breastfeeding changes both I'mmune system" "gastrointestinal hormones - gastrin, chloecystokinin - CORRECT ANSWER promote induced insulin release and growth promoting effects in the gut" "gastrointestinal hormones - somatastin - CORRECT ANSWER inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut" "pregnancy & breastfeeding in re: to T2DM - CORRECT ANSWER pregnancy itself may bring an increased risk for Type 2 diabetes in the mother, which breastfeeding can negate. compared with women who have not had children, childbearing women who do not breastfeed have a 50% increased risk of T2DM in later life" "weight loss in the BF neonate - CORRECT ANSWER in first date after birth, most babies lose weight, some from normal diureses" "AAP weight loss stance in 2005 - CORRECT ANSWER "weight loss in the infant of greater than 7% from birth weight indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible intervention to correct problems and improve milk production and transfer"" "AAP weight loss stance in 2012 - CORRECT ANSWER added "evaluate body weight gain - body weight loss no more than 7% from birth and no further weight loss by day five: assess feeding and consider more frequent follow-up"" "by two weeks at the latest: - CORRECT ANSWER the baby should regained to its birth weight" "infants lose more weight in the first postpartum days... - CORRECT ANSWER - when labor meds are used... but perhaps not at a baby-friendly hospital - when more intrapartum fluids have been given - when there was no labor prior to cesarean however, supplementation rates for weight loss decreased with routine use of 24 hr weight and did not increase untoward effects during the hospital stay" "what do we know about breastfed babies who become dangerously undernourished? - CORRECT ANSWER report by cooper & colleagues identified a significant increase in the incidence of malnutrition and hypernatremia in breastfed infants - 5 sentinel cases in ohio began a chart review of the prior 4 years - chart review babes were 23% below birth weight on average on readmission and showed clinical signs of dehydration and hypernatremia - babies were: not d/c early, nursing q 3-4 or 4-6 hrs, scheduled, both breasts, 5-10. min a side, SLEEPY - researchers found: the class was inadequate, inadequate follow up in the community post-partum" "how do you know about breastfeeding adequacy? - CORRECT ANSWER fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may indicate breastfeeding inadequacy - four on four... and each day after" "cooper findings re: weight loss findings - CORRECT ANSWER - babies were not identified before 10% weight loss - a "contented" (sleepy) baby is NOT a well-fed baby (calorically deprived babies are sleepy)" "breastfeeding associated hypernatremia - CORRECT ANSWER hypernatremia is a common complication of inadequate milk transfer during breastfeeding - completely preventable complication that seems to be relatively common" "hypernatremia weight loss difference - CORRECT ANSWER 1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants" "hypernatremia frequency of feeds difference - CORRECT ANSWER 10.2 for healthy infants vs. 7.6 in the NHD admitted infants" "how has the AAP responded to hypernatremia? - CORRECT ANSWER - ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift - all breastfeeding newborn infants should be seen by a pediatrician at 3-5 days of age, which is within 48-72 hours after discharge from hospital - evaluate: hydration (elimination patterns), body weight gain (body weight loss no more than 7% from birth and no further weight loss by day 5), discuss maternal/infant issues - observe feeding" "MYTH - size of the breast relates to the amount of milk - CORRECT ANSWER the proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production. for health providers, perceptions of who will have difficulty with breastfeeding may be related to breast size." "MYTH - not getting enough fluids impacts volume of milk - CORRECT ANSWER there is not enough evidence to support increasing fluid intake beyond with breastfeeding mothers are likely to require to meet their physiologic needs" "MYTH - exercising or working too hard impacts supply - CORRECT ANSWER maternal exercise when breastfeeding was not related to changes in macronutrients or volume or infant weight gain or growth. rest is not associated with increased milk production." "MYTH - not getting enough rest - CORRECT ANSWER "fatigue" may be tiredness, but also may be a symptom of an underlying medical problem that could affect milk supply." "MYTH? worry/stress?? - CORRECT ANSWER increased worry/stress does not seem to directly diminish milk supply in humans, however... - worry/stress may alter behavior, which may alter supply" "maternal stress - CORRECT ANSWER breastfeeding mothers may perceive less stress compared to formula fed mothers, breastfeeding mothers: - had more positive moods - reported more positive events - perceived less stress" "how is it possible for humans to make milk with such a small amount of energy expenditure? - CORRECT ANSWER - maternal plasma prolactin concentration generally increases under conditions of negative energy balance, which may serve to protect lactation - changes in maternal processes can spare energy.. this may account for a third to half of the total costs of milk synthesis - together with the low cost of human lactation and large fat reserves from pregnancy, may account for human ability to breastfeed our infants under nutritional conditions which are often far from ideal" "how do we assure an adequate milk supply? - CORRECT ANSWER - universal understanding of how breastfeeding works - early initiation and adequate breastfeeding (10-12x/daily) - appropriate breastfeeding assessment - improved and early breastfeeding support to decrease "lactastrophes" - appropriate HCP and LCP follow-up in the postpartum (see reasons to refer) - admitting theres no magic bullet" role of oxytocin in breastfeeding. - CORRECT ANSWER Oxytocin is a hormone released during breastfeeding that stimulates the let-down reflex, causing the muscles around the alveoli to contract and release milk." "Describe the composition of colostrum and its benefits for newborns - CORRECT ANSWER Colostrum is the first milk produced by the mammary glands after childbirth. It is rich in antibodies, proteins, and nutrients, providing essential immune protection and nutrition for the newborn." "What are the signs of a proper latch during breastfeeding - CORRECT ANSWER Signs of a proper latch include the baby's mouth covering a large portion of the areola, lips flanged out, and rhythmic sucking with audible swallowing" "What are the nutritional components of breast milk - CORRECT ANSWER Breast milk contains carbohydrates, proteins, fats, vitamins, minerals, antibodies, and enzymes essential for infant growth and development." "Why is breastfeeding so difficult that mothers need help - CORRECT ANSWER Reason #1 Unrealistic expectations Reason #2: Lack of timely interventions" "What are some unrealistic expectations - CORRECT ANSWER Lack of preparation for what the newborn period would be like" "When is the greatest chance of quitting breastfeeding - CORRECT ANSWER Mother's problems at 3 to 7 days posed the greatest risk to stopping The fastest drop-off is in the 10 days following discharge from the hospital" "Woman who do not breastfeed are at greater risk for - CORRECT ANSWER breast, ovarian & endometrial cancers myocardial infraction & asepcts of metabolic syndrome" You are discussing allergies in a prenatal breastfeeding class. One of the facts you want to point out is that many of the babies who are allergic to cow's milk protein can also be sensitive to: a) Wheat b) Corn c) Soy d) Eggs - CORRECT ANSWER c) Soy" "Julie, a first time mom, tells you that her baby was very fussy last night, which was the baby's second night. You know that this is most likely due to: a) Her milk isn't in yet, and the baby is hungry b) She's exhausted and is magnifying the situation c) The mom is uptight and transmitting her nervousness to the baby d) Overwhelming CNS stimulation in the baby - CORRECT ANSWER d) Overwhelming CNS stimulation in the baby" "Alyssa reports that Ethan falls asleep whenever the nurses bring him to here to breastfeed. Which of the following would be the most helpful advice? a) Room-in with Ethan, watching him for feeding cues b) Wake him by washing his face with a cool, damp cloth c) Make sure the nurses bring him in as soon as he cries d) Coax him to the breast using drops of glucose water on the nipple - CORRECT ANSWER a) Room-in with Ethan, watching him for feeding cues" "Babies who have early contact with their mothers and who were provided with postpartum support are more likely to: a) Have a faster weight gain than babies who are separated from mom b) Be able to sleep in their own room by one month c) Be breastfed long enough to meet the mother's goals d) Breastfeed more frequently at night - CORRECT ANSWER d) Breastfeed more frequently at night" "On the physical exam of a 28-week preterm infant , which of the following is likely to be found? a) Lanugo all over the body b) Dry and peeling skin c) Palpable breast buds d) Ability to coordinate suck, swallow, and breathe - CORRECT ANSWER a) Lanugo all over the body" "For a mother to have adequate levels of vitamin D in her milk in order to pass at least 400 IU to the baby, she needs to: a) Use a sun screen of less than SPF 30 when out in the sun b) Have a 25-(OH)-D serum level of at least 58 ng/mL c) Take 400 IU of vitamin D each day of her pregnancy d) Drink 3, 8 oz. glasses of vitamin D fortified milk a day and have fish high in vitamin D 2x/week - CORRECT ANSWER b) Have a 25-(OH)-D serum level of at least 58 ng/mL" "A "nursing strike" may occur because of: a) Introduction of solid foods b) Infant no longer has an interest in the breast c) Start of mother's menses d) Mother starts a food reduction program - CORRECT ANSWER c) Start of mother's menses" "Florence birthed Josh at 32 weeks of gestation. Which of the following would be the first thing to include as a part of her pumping plan? a) Begin expressing within the first hour post-birth b) Determine her nipple size to provide her with the appropriate flange c) Use a hospital grade breast pump d) Pump using a double pumping system - CORRECT ANSWER a) Begin expressing within the first hour post-birth" "Increased rates of autism spectrum disorders (ASD) are seen in children who: a) Received less than 1 hour of skin-to-skin after birth b) Received formula supplements in the first week of life c) Were formula-fed from the beginning of life d) Were exclusively breastfed for less than 3 months - CORRECT ANSWER c) Were formula-fed from the beginning of life" "Which of the following statements about lactose in human milk is true? a) Lactose provides 60% of the calories in human milk b) Lactose is essential for CNS development c) Lactose is decreased in human milk when the mother eliminates dairy d) Lactose concentration decreases from 2-16 weeks - CORRECT ANSWER b) Lactose is essential for CNS development" "Daisy, who is 21 days postpartum, is seen in the outpatient clinic with burning, painful, red nipples for the last 4 days. Which of the following is most likely to be a cause of her sore nipples? a) Baby has a shallow latch b) Allergic reaction to lanolin c) Her infant is tongue tied d) She has a yeast infection - CORRECT ANSWER d) She has a yeast infection" "Hope is 3 weeks postpartum and doesn't have enough breast milk. Her history and exam haven't yielded any reason for the low supply. Which test would you want to have done first to possibly provide a reason for low milk supply? a) Thyroid levels b) Iron levels c) Testosterone levels d) Serum prolactin levels - CORRECT ANSWER a) Thyroid levels" "Josey just delivered 29 week infant, Henry, by c-section because of high blood pressure and increasing amounts of protein in her urine. Which of the following is most likely to contribute to Josey have a low milk supply. a) Josey delivered by c-section b) Josey didn't start pumping until 6 hours after the birth c) Josey's average pumping frequency was 7-8 times per day d) Josey had pre-eclampsia at the time she delivered - CORRECT ANSWER a) Josey delivered by c-section" "A potential milk donor may be excluded by the Human Milk Banking Association if the mother: a) Has a 6 oz. glass of wine on a daily basis b) Has been a practicing vegetarian for the last 3 years c) Received a blood transfusion in the past 4 months d) Has had influenza in the previous year - CORRECT ANSWER c) Received a blood transfusion in the past 4 months" "Which of the following is an important component of the Baby Friendly Hospital Initiative? a) Adhering to the International (WHO) Code b) Following the Bellagio Consensus c) Minimize interventions in labor and delivery d) Providing follow-up for breastfeeding mothers and babies - CORRECT ANSWER d) Providing follow-up for breastfeeding mothers and babies" "Cheryl calls the lactation hot-line complaining that her milk supply is decreasing. She also says that 4-week-old Ronnie spits up a lot and there appeared to be streaks of blood in his stool earlier in the day. What is your first suggestion? a) Take Ronnie to his pediatrician for an evaluation b) Visit the lactation clinic immediately for an evaluation and feeding assessment c) Have the mother record everything she has eaten in the last 48 hours to determine what food is causing the symptoms d) Tell the mother to eliminate dairy products for 14 days. Then keep a record of Ronnie's spitting and a description of his stools - CORRECT ANSWER a) Take Ronnie to his pediatrician for an evaluation" "One of the main reasons for the decline of breastfeeding in the 19th century was: a) The belief that formula was scientific and was equated with progress b) Lack of support for nursing mothers by the medical community c) The though that breast milk composition could only be controlled through controlling women d) Because only poor women breastfed - CORRECT ANSWER a) The belief that formula was scientific and was equated with progress" "A slow weight gaining infant will: a) Have a decrease in frequency and amount of stool b) Consistently gain weight, but slowly c) Sleep for exceptionally long periods between feedings d) Is more apathetic than an infant with a good weight gain - CORRECT ANSWER b) Consistently gain weight, but slowly" "Which of the following elements in a woman's history probably will have a negative impact on her breastfeeding success? a) Hypothyroidism treated with thyroid supplements b) Loss of blood during delivery requiring 2 units of blood c) Previous low milk supply treated with use of galactogogues d) No breast changes during pregnancy or within the first month postpartum - CORRECT ANSWER d) No breast changes during pregnancy or within the first month postpartum" "Marci comes in saying that 21-day-old Jason is very fussy, has lots of gas and at least 8 watery yellow stools per day. He is at his birth weight of 7 lbs., 14 oz. He has a stool while you are examining him that is yellow/green, but without any solid matter.. Which condition would be your first hunch? a) Hyperlactation syndrome b) Cow's milk protein allergy c) Neonatal colitis d) FTT due to insufficient feeds - CORRECT ANSWER a) Hyperlactation syndrome" "Facilitating is an effective counseling skill because: a) The mother is allowed to talk b) The mother is encouraged to listen c) The counselor focuses on the mother's specific concern d) The counselor focuses on the mother's feelings - CORRECT ANSWER c) The counselor focuses on the mother's specific concern" "Which of the following would be most likely to positively impact a mother using a pump correctly? a) Using a pump manufactured from a company that only focuses on breastfeeding b) Reading the direction before using the pump c) Shown how to use from another person, like a friend d) Only use rental pumps - CORRECT ANSWER c) Shown how to use from another person, like a friend" "You are preparing a list of handouts to use in your breastfeeding class for parents. The most important guidelines you need to consider when selecting your handouts should be: a) Information must be current and consistent b) Handouts should have a 4th grade reading level and lots of white space c) Include information on references for IBCLCs in your community d) Information should include common situations which may occur after the mom is discharged - CORRECT ANSWER a) Information must be current and consistent" "Exclusive breastfeeding is more likely to occur if: a) The infant weighed 8 lbs. or more b) Did at least 30 minutes of skin-to-skin after birth c) Wasn't bathed for 4 hours post birth d) Mother who had a c-section did skin-to-skin in the recovery room - CORRECT ANSWER a) The infant weighed 8 lbs. or more" "Krystal Starr is undecided about whether or not to breastfeed her baby because she smokes a pack of cigarettes per day. Which of the following is the most important to discuss with her? a) Unless she can cut down to 15 cigarettes or less per day, she should not breastfeed b) She should never smoke around the baby, and only after the baby has been fed c) It's not uncommon for babies whose mothers smoke to be more colicky than babies whose mothers don't smoke d) It's far better for the baby's health that a smoking mother breastfeed than formula-feed - CORRECT ANSWER d) It's far better for the baby's health that a smoking mother breastfeed than formula-feed" "The most beneficial method employers can use to assist mothers to continue breastfeeding after returning to work is: a) Provide a lactation support system b) Provide an electric breast pump c) Provide healthy snacks in pumping room d) Provide a home visit after delivery - CORRECT ANSWER a) Provide a lactation support system" "Robyn visits the outpatient clinic stating 10-day-old baby, Jeffery, isn't receiving enough milk. You note he latches well, he is positioned appropriately. Jeffery has good body tone and a nice strong, coordinated suck. Upon released from the breast, you see that the nipple is nicely rounded. You do ac/pc weights and you find little milk is transferred. Possible reasons for the poor transfer of milk include which of the following: a) Bilateral breast reduction surgery b) Damage to the 3rd intercostal nerve c) Maternal weight gain of 25 lbs. d) Mother with T2DM - CORRECT ANSWER a) Bilateral breast reduction surgery" "You are teaching a course in lactation management and Kara, one of the students, asks if a mother has to have a radioactive isotope for which she needs to pump her milk, does she need to dump the milk in every instance. You tell her that: a) Yes, it's important to dump the milk b) That is an excellent question to which no one knows the answer c) Because the antioxidants decrease in milk after 48 hours, it's not recommended that the milk be stored longer than that period of time d) If she freezes the milk for 8-10 half-lives, the radioactivity will be virtually eliminated - CORRECT ANSWER d) If she freezes the milk for 8-10 half-lives, the radioactivity will be virtually eliminated" "Fatty acids in breast milk... a) Are increased by an increase of fat in the maternal diet b) Are synthesized by the mammary gland c) Decrease slowly over the first two months d) Are detrimental to infant neural development - CORRECT ANSWER b) Are synthesized by the mammary gland" "You are visiting your friend Alexandra and her son, Samuel. You notice Samuel pulling himself to a standing position and taking a few steps while hanging on to the couch. You know that the average age for this milestone is: a) 7-9 months b) 9-12 months c) 12-14 months d) 14-18 months - CORRECT ANSWER b) 9-12 months" "Cindy calls you saying her internist prescribed a new drug, "Diabloc" for her Crohn's disease. She wonders if it's compatible with breastfeeding. Which of the following properties of "Diabloc" might cause you to investigate further the safety of the use of the drug in breastfeeding mothers? a)