ELCA/CSPM FINAL EXAM 2007 14 JULY, 2007

Which of the following increases an infant’s difficulty in achieving a secure latch onto the .1
?breast
A) an intact palate
B) a tongue that is firmly anchored by the frenulum
C) a tongue that cups up at the edges
(D) a mouth that is comfortable (not sore
The practice of hand-feeding foods other than breastmilk before a neonate is put to breast is .2
:MOST LIKELY linked to
A) highly industrialized societies
B) traditional and industrialized societies
C) concern about safety of such feeds
D) only in traditional societies
As compared with infants fed manufactured milks, breastfed infants MOST LIKELY tend to .3
:have
A) less illness because breastmilk immunoglobulins help the infant resist bacteria
B) less illness because the protein in breastmilk is more dilute
C) more illness because the nutritional status of artificially fed infants is better
D) more illness because of the relatively dilute nature of breastmilk
Most research studies on the effect of lactation consultant advice to a breastfeeding mother .4
: show that
A) casual advice does not increase the prevalence or duration of breastfeeding
B) lactation consultant advice can increase duration but not initiation of breastfeeding
C) almost any exchange between lactation consultants and new mothers increases the duration of
breastfeeding
D) in rural populations, lactation consultant advice may or may not promote breastfeeding, whereas
in metropolitan populations it does
As an LC, you see a mother and young breastfeeding infant for recent poor weight gain. You .5
?note that the infant is feverish and listless. What do you do now
.A) Evaluate recent breastfeeding behavior and suggest ways to stimulate the baby
B) Evaluate recent breastfeeding behavior, suggest ways to stimulate the baby, and offer suggestions
.on how to reduce fever in an infant
C) Evaluate recent breastfeeding behavior, suggest ways to stimulate the baby, offer suggestions on
how to reduce fever in an infant, and mention the possibility that the baby should be seen by
.the family’s health-care provider
D) Refer the mother and baby to the family’s health-care provider; assure the mother that you will
.return to breastfeeding problems after the baby has been evaluated for medical problems
A lateral incision at which of the following positions is MOST LIKELY to sever the nerve that .6
?innervates the nipple and areola
A) eight o’clock on the right, four o’clock on the left
B) five o’clock on the right, seven o’clock on the left
C) ten o’clock on the right, two o’clock on the left
D) nine o’clock on the right, three o’clock on the left
After the placenta is delivered, changes in hormone concentration that take place are MOST .7
:LIKELY to be
.A) Concentrations of progesterone, prolactin, and oxytocin rise
.B) Concentration of progesterone remain stable, but concentrations of prolactin and oxytocin rise
.C) Concentrations of progesterone and prolactin fall, but concentration of oxytocin rises
.D) Concentration of progesterone falls, but concentrations of oxytocin and prolactin rise
As compared with a mother who exclusively breastfeeds, a mother who supplements her .8
.____________ breastfeeding infant with formula will experience
A) higher plasma concentrations of oxytocin and prolactin
B) lower plasma concentrations of oxytocin and prolactin
C) higher plasma concentration of oxytocin, but lower plasma concentration of prolactin
D) lower plasma concentration of prolactin, but higher plasma concentration of oxytocin
.____________ Nonnutritive suckling by premature infants decreases .9
A) secretion of digestive fluids
B) gastrointestinal peristalsis
C) time spent in quiet alert state
D) crying
.____________ Compared with mature milk, colostrum is .10
A) richer in protein but lower in minerals and carbohydrates
B) richer in fats but lower in protein and minerals
C) richer in protein and minerals but lower in carbohydrates and fats
D) richer in carbohydrates but lower in protein
.____________ During a given feeding, the fat concentration of human milk .11
A) is remarkably stable throughout
B) is inversely related to the degree to which the breast is emptied
C) is higher the longer the interval since the last feeding
D) is directly related to the degree to which the breast is emptied at that feeding
:In their first several months, healthy breastfed infants rarely need iron supplements .12
A) because lactose and vitamin C in breastmilk facilitate absorption of iron
B) because breastmilk is naturally high in iron
C) if the mother herself regularly ingests an iron supplement
D) with the exception of infants of vegetarian mothers
The intestinal environment of the fully breastfed infant discourages the proliferation of .13
.____________ coliform bacteria because
A) gram-positive lactobacilli and L. bifidus are only minor fecal flora
B) it discourages the growth of a lactobacilli-promoting factor
C) factors in breastmilk sequester coliform bacteria by promoting their adhesion to the intestinal wall
(D) it has a low pH (i.e., it is acid
?The transfer of most drugs into human milk involves which of the following .14
A) active transport
B) a concentration gradient
C) ionized or bound compounds
D) an impermeable membrane
The best way to minimize transfer of maternal medications to a breastfeeding infant is to use .15
.____________ medications that have a
A) long half-life and are taken right after a feeding
B) short half-life and are taken right after a feeding
C) long half-life and are taken right before a feeding
D) short half-life and are taken right before a feeding
?Which of the following factors is LEAST likely to promote jaundice .16
A) induction of labor
B) mother with diabetes
C) cephalhematoma
D) appropriate for gestational age term birth
:Mothers who use penicillins or cephalosporins have been shown to produce breastmilk that is .17
A) high in both penicillins and cephalosporins
B) low in both penicillins and cephalosporins
C) high in penicillins but low in cephalosporins
D) high in cephalosporins but low in penicillins
According to a 1999 study, exclusive breastfeeding appears to offer some protection against .18
._____________ HIV transmission to infants in third world areas PRIMARILY because it
A) confers immunologic protection
B) contains vitamin A
C) protects the infant’s intestinal mucosal barrier
D) avoids contamination from early solid foods
._______________ Cultural relativism refers to .19
A) a belief that one’s own culture embodies the only right way in which to live
B) an appreciation of one’s relatives and how they live and work
C) recognizing that all cultures share the same values
D) an appreciation and acceptance of different cultural norms
._____________ Infants born to women with a history of hepatitis B virus .20
A) should breastfeed, because infants not breastfed are more likely to contract the disease
B) should not breastfeed, because breastfed infants of infected mothers have a higher rate of hepatitis
B infection
C) should breastfeed, because breastfeeding lowers the mother’s plasma concentration of this virus
D) should not breastfeed, because virus in breastmilk stresses the infant’s immature liver
._____________ Epidural analgesia during labor has been associated with .21
A) early neonatal suckling and increased suckling vigor
B) delayed neonatal suckling and reduced suckling vigor
C) early neonatal suckling but reduced suckling vigor
D) delayed neonatal suckling but increased suckling vigor
Low progesterone concentrations in the blood may be associated with feelings of .22
._______________
A) relaxation
B) increased energy
“C) “all’s right with the world
D) vulnerability
Because a baby born by cesarean section may not latch onto the breast well in the early .23
?postpartum, which is the BEST action to take
.A) Delay first breastfeeding until baby clears maternal analgesia or anesthesia from his system
.B) Put the baby to breast in the first few hours after birth
.C) Encourage the mother to immediately begin pumping her breasts to hasten lactogenesis II
.D) Encourage the mother to immediately begin pumping her breasts to improve later milk transfer
:Massage of the lactating breast, a common practice in many cultures, is thought to .24
A) decrease lymphatic drainage
B) reduce or eliminate intraductal cysts
C) increase milk production
D) be contraindicated during breast engorgement
:The International Labour Organization promotes the right of women to .25
A) breastfeed in the workplace
B) have access to all professions
C) be paid wages comparable to those paid men in comparable jobs
.D) qualify for child subsidies so they may leave the paid workforce during their child-bearing years
._____________ Breasts will begin to involute if .26
A) only about 80% of the milk in the breast is removed consistently
B) components in the milk promote proliferation of lactocytes
C) distension of the lumen of the milk alveoli disrupts the lactocytes
D) they have excess milk storage capacity
Breastfeeding infants who develop colic symptoms in response to certain foods in their .27
._____________ ,mother’s diet are, later in life
A) protected against allergic reactions to those foods
B) likely to show allergic reactions to those foods
C) at no increased or decreased risk of showing allergic reactions to those foods
D) at greater risk of obesity
._____________ Retractile inverted nipples .28
A) are so firmly inverted that they cannot be pulled out
B) may be caused to evert more easily by the changes of pregnancy
C) make it very difficult for a baby to draw the nipple into her mouth
.D) are inverted when at rest and after manipulation
Mothers are most likely to rate which of the following factors as the most important precursor .29
?of mastitis
A) plugged duct
B) cracked nipple
C) fatigue
D) milk stasis
In order to eliminate a woman’s recurrent yeast infection, which of the following should be .30
?treated
A) the woman only
B) the woman and her sexual partner
C) the woman, her sexual partner, and the baby
D) the woman, her sexual partner, the baby, and items that regularly go into the baby’s mouth
Recommend that a lactating woman be examined by her health-care provider if she notices .31
._____________
A) a persistent difference in breast size
B) a breast lump that does not change during 3 days of normal breastfeeding
C) cracked nipples that leak blood into her breastmilk
D) bouts of mastitis that move to different locations in the breasts
._______________ Maternal nutritional status bears .32
A) a strong direct relationship with milk volume
B) a strong direct relationship with fat content
C) an inverse relationship with milk volume
D) little correlation with milk volume
During the first 4 weeks, the root cause of poor weight gain in a breastfeeding infant is .33
._______________
A) more likely to be feeding problems than underlying infant illness
B) more likely to be underlying infant illness than feeding problems
C) equally likely to be feeding problems and underlying illness
D) more likely to be maternal indifference than underlying infant illness
For optimal learning and change in behavior, the ideal group size ranges from .34
._______________
A) 1 to 5 persons
B) 4 to 8 persons
C) 8 to 12 persons
D) 10 to 15 persons
Which of the following breastfeeding patterns is thought to have typified human groups before .35
?.10,000 B.C
A) frequent but brief breastfeeding bouts, day and night
B) total duration of breastfeeding of only a few months
C) infrequent daytime breastfeeding bouts coupled with frequent nighttime bouts
D) infrequent but long breastfeeding bouts
._______________ In nearly all cases, milk production is related more to .36
A) effective breastfeeding by the baby than to maternal ability to make milk
B) maternal ability to make milk than to effective breastfeeding by the baby
C) maternal nutritional status than to size of the baby at birth
D) size of the baby at birth than to maternal nutritional status
.Most newborns have passed the first meconium stool within the first ____ hours after birth .37
A) 4
B) 8
C) 16
D) 24
._______________ Use of a thin silicone nipple shield is MOST likely to .38
A) increase milk transfer by enabling an infant to more easily grasp the nipple
B) increase the discomfort of a mother with very sore nipples
C) decrease milk transfer by triggering an infant’s gag reflex
D) eliminate the need to pump the breasts
._______________ One feature of jaundice is .39
A) a deep reddish tinge to the skin
B) increased excretion of bilirubin
C) deposition of biliverdin in tissues
D) increased hemoglobin breakdown
?Which of the following factors is LEAST likely to promote jaundice .40
A) induction of labor
B) mother with diabetes
C) cephalhematoma
D) appropriate for gestational age term birth
Which of the following activities is NOT prohibited by the World Health Organization's .41
?International Code of Marketing of BreastMilk Substitutes
A) "gift packs" containing samples and coupons for formula given to new mothers at hospital
discharge
B) detailed information on product composition provided to health workers
C) advertisements for toddler formula on local television stations
D) picture of a happy baby on the label of infant-formula, containers
._______________ Kernicterus—bilirubin staining of brain tissue—is .42
A) no longer a public health issue since the advent of phototherapy
B) less likely in breastfeeding infants because of protective factors in breastmilk
C) a greater risk for infants who experience early “breast-nonfeeding” jaundice
D) a condition that the baby will eventually grow out of
Booklets describing how to breastfeed that emphasize difficulties, discomfort, and .43
._______________ inconvenience are more likely to
A) prepare the mother for the realities she will face
B) be prepared by companies that sell manufactured baby milks
C) be prepared by organizations that promote breastfeeding
D) be prepared by organizations that support breastfeeding mothers
A lactation consultant who recommends that a mother use nipple shields should also .44
._______________
A) ask the mother to sign a consent form identifying the risks of using the device
B) suggest that nipple shields should be used until the baby weans
C) note that only neurologically impaired babies benefit from their use
D) note that the shield will alter the baby’s suck, preventing later attachment to the breast
The principal mechanism by which pumps cause milk to flow from the breast is by .45
._______________
A) suction, like sucking on a straw
B) mechanical kneading of the breast that squeezes milk out
C) mimicking the sensations produced by a baby at the breast
D) creating a pressure gradient down which milk flows
To ensure the safety of an infant born to a pregnant woman infected with herpes simplex .46
._____________ virus, vaginal delivery is
A) always contraindicated
B) contraindicated if active genital lesions are present at delivery
C) contraindicated if the mother acquired her virus infection during this pregnancy
D) contraindicated if the mother acquired the virus some time before this pregnancy
._______________ A mother whose baby is unable to feed from the breast should pump about .47
A) 8 times in 24 hours around the clock
B) 8 times in 24 hours but not necessarily at night
C) 5 or 6 times in 24 hours around the clock
D) 5 or 6 times in 24 hours but not necessarily at night
._______________ Freshly pumped breastmilk .48
A) is sterile
B) usually contains only nonpathogenic bacteria
C) contains bacteria only if the mother’s pumping equipment or technique permits bacterial
contamination
D) contains bacteria only if the mother herself has a bacterial infection
The nipple soreness that may accompany breast pumping can be reduced by all of the .49
._______________ following EXCEPT
A) using a flange that allows some free space around the nipple
B) using a relatively high vacuum setting to shorten the duration of pumping
C) eliciting a letdown before applying a vacuum
D) switching from one side to the other as milk flow dwindles
Nonnutritive sucking at the breast usually affects the mother’s milk supply by .50
._______________
A) reducing the amount of milk she is able to pump
B) increasing the volume of milk she can pump
C) having no particular effect on the volume she can pump
D) increasing maternal milk volume only when the baby is about to be released home
A mother who is able to pump about 800 ml of breastmilk per day for her small, 14-day-old, .51
._______________ preterm infant has
A) fewer alveolar cells in the breast than mothers who pump lesser volumes
B) an unnecessarily large milk supply, considering the very small volumes consumed by small
preterm infants
C) a milk supply large enough to withstand a substantial decline during her infant’s hospitalization
D) an underlying medical condition causing milk overproduction
._______________ A galactagogue refers to any .52
A) person who openly advocates breastfeeding
B) food believed to increase milk secretion
C) food believed to dry up a mother’s milk
D) food that promotes the breakdown of galactose
The MOST important principle, of those listed below, of adult education is to .53
._______________
A) present information in large, comprehensive blocs
B) provide specific feedback at a later date, to reinforce student learning
C) provide take-home handouts instead of individualized assessment
D) mesh the information presented with students’ readiness to learn that information
A woman who immigrates to the United States from Southeast Asia and who has some .54
._______________ children born abroad and some in the US is likely to
A) breastfeed all of her children
B) bottle-feed all of her children
C) breastfeed children born abroad but bottle-feed children born in the US
D) bottle-feed children born abroad but breastfeed children born in the US
The optimal frequency of breast pumping in the first week following a premature birth is .55
._______________
A) 4 to 6 times a day, because that number stimulates the breasts but does not over-tire the mother
B) 5 to 7 times in 24 hours, because that number of pumpings means that each pumping session can
be shorter
C) 6 to 8 times in 24 hours, because that number of pumpings more closely mimics the number of
times a healthy term baby would breastfeed
D) 8 to 10 times a day, in order to stimulate a large milk supply
As compared with preterm infants fed manufactured milk, preterm infants fed human milk .56
._______________ tend to grow less rapidly, perhaps because
A) age-appropriate human milk is less calorie dense than manufactured milks
B) a greater proportion of human milk is excreted than is metabolized and used for growth
C) the volumes of human milk being fed are too small
D) human-milk–fed infants are more active and use more calories when they are awake
?Which of the following practices is NOT used to guarantee the safety of human milk donors .57
A) heat treatment of all donated milk
B) screening of potential donors for health history and risk factors
C) serological screening of potential donors for certain viruses
D) prevention of donation by mothers whose babies have died
In the World Health Organization hierarchy of foods for young infants, the first choice is .58
._______________ always
A) a manufactured milk with denatured proteins
B) donor breastmilk
C) mother’s breastmilk
D) gruel or other culturally traditional food
As compared with mothers who feed artificial milks to their infants, breastfeeding mothers in .59
._______________ the first year postpartum tend to
A) lose more weight
B) lose less weight
C) lose about the same amount of weight
D) lose more weight but only in the first 3 or 4 months
How is the calcium intake of a breastfeeding mother related to the calcium content of her .60
?milk
A) to a moderate degree
B) to a large degree if she takes calcium supplements
C) to a large degree if she obtains all calcium from foods
D) not at all
._______________ The essential amino acids that are required for protein synthesis .61
A) are manufactured in the body
B) can be obtained only from animal foods
C) can be obtained from animal and vegetable sources
D) can be obtained only from mixing vegetable sources
._______________ A lactating woman who intends to consume alcohol should .62
A) take no special precautions because alcohol is rendered harmless in the infant’s stomach
B) take no special precautions because little alcohol crosses into breastmilk
C) consume alcohol on an empty stomach so it will metabolize faster
D) consume small amounts along with other foods so it will metabolize slowly
._______________ A diabetic mother who is ready to wean her infant should .63
A) wean rapidly, because it’s better to deal with the change to her body during only a short interval
B) wean rapidly, because then she can enjoy an interval of high calorie intake
C) wean slowly, because she can then gradually decrease her own food intake
D) wean slowly, because she can then gradually decrease her insulin dosage
During pregnancy, the breast enlarges under the influence of several hormones. Milk ducts .64
grow and branch under the influence of ___________, whereas the lobes, lobules, and
.___________ alveoli grow under the influence of
A) estrogen, placental lactogen
B) estrogen, progesterone
C) prolactin, progesterone
D) progesterone, estrogen
._______________ When a mother must have surgery, she should be encouraged to .65
A) breastfeed as late before and as soon after surgery as possible
B) begin pumping her breasts 12 hours before surgery and continue for 36 hours afterwards
C) breastfeed before the surgery and then pump her breasts for the first week postsurgery
D) wean the baby in advance of the surgery to make her life less stressful
._____________ During early breastfeedings, the mother should breastfeed a neonate .66
A) only on one breast
B) on one or both breasts at the baby’s discretion
C) for no longer than 10 minutes on the first breast or 20 minutes on the second breast
D) for no longer than 20 minutes on the first breast but as long as the baby desires on the second
._______________ Mothers who express breastmilk at their place of employment .67
A) are more likely to miss work because of breast infections
B) are more likely to leak milk
C) are less likely to miss work because of illness in their infants
D) are more susceptible to milk stasis
._____________ Prompt lactogenesis II is promoted by .68
A) intact anterior pituitary
B) insulin-dependent diabetes
C) cesarean delivery
D) obesity
:All of the following statements about breast asymmetry are untrue EXCEPT .69
.(A) Breasts almost always are of the same size (symmetrical
.B) Any breast asymmetry should be considered a marker for problems producing milk
.C) When breasts are asymmetrical, the right breast usually is larger than the left
.D) Markedly asymmetrical breasts should be considered a marker for problems producing milk
Research on the effect of maternal paid employment on breastfeeding indicates that .70
._______________
A) planned return to work does not change the rate of breastfeeding initiation, but it does shorten the
overall duration of breastfeeding
B) planned return to work lowers both the rate of breastfeeding initiation and overall duration of
breastfeeding
C) working full time rather than part time lengthens overall breastfeeding duration
D) the younger an infant when the mother returns to work, the longer the overall duration of
breastfeeding
._______________ Motor development in a child progresses from .71
A) small muscle control to large muscle control
B) feet and legs to arms and head
C) large muscle control to small muscle control
D) trunk first, then legs, then arms
:Worldwide and throughout history, the factor MOST strongly linked with infant mortality is .72
A) a decline in rates of breastfeeding
B) poverty
C) use of Western-style feeding patterns in non-Western settings
D) the local advent of industrialization
In general, adolescent mothers follow the same breastfeeding pattern as adult women in that .73
._______________
A) their breastfeeding initiation rates are about the same
B) older teen mothers are more likely to breastfeed than younger teen mothers
C) their breastfeeding continuation rates are about the same
D) each subsequent child is breastfed for fewer months
Significant others in a breastfeeding mother’s life who support her breastfeeding usually .74
._______________
A) are necessary for long-term breastfeeding
B) are nice but not necessary to continued breastfeeding
C) are best kept at a distance, because they just get in the mother’s way
D) try to undermine the close breastfeeding relationship
A fully developed, functional central nervous system is indicated in a neonate who .75
._______________
A) blinks her eyes
B) moves rapidly between alert, fussy, and sleep states
C) coordinates suck and swallow
D) has a strong startle reflex
Both hypotonic infants and hypertonic infants are more likely to obtain more milk from the .76
._______________ breast if the mother uses
A) breast shells
B) a feeding-tube device at the breast
C) timed feedings
D) a thin silicone nipple shield
As compared with infants fed manufactured milks, immunization of breastfed children .77
._______________
“A) should be delayed until after weaning to assure that the immunization “takes
B) usually results in a higher antibody concentration
C) should be on a different schedule
D) should be avoided in order to avoid a possible adverse reaction to the immunization medium
._______________ Small per-bottle fees charged per bottle of donor milk cover the cost of .78
A) shipping, screening donors, and the milk itself
B) screening donors, the milk itself, and pasteurization
C) the milk itself, pasteurization, and shipping
D) pasteurization, shipping, and screening donors
A breastfeeding infant who presents with pronounced dehydration resulting from an acute .79
._______________ gastrointestinal illness should be fed
A) only breastmilk
B) only oral rehydration solution
C) only a soy-based manufactured baby milk
.D) breastmilk and oral rehydration solution
As compared with first-time mothers, multiparous mothers produce ______ milk at 1 week .80
.postpartum
A) more
B) less
C) about the same amount of
D) more calorie-dense
.___ Treatment for mild dehydration during gastroenteritis in breastfeeding infants includes .81
A) continued breastfeeding and rehydration fluids if needed
B) interrupted breastfeeding and breast pumping during the acute phase of the illness while the child
receives oral rehydration solutions
C) continued breastfeeding and formula supplementation
D) hospitalization with intravenous fluids and electrolytes
?An infant with an unrepaired cleft palate will find breastfeeding easiest in which position .82
A) prone on mother’s chest
B) side-lying
(C) football (clutch
D) upright
._______________ Frozen or refrigerated mothers’ milk should be warmed before feeding by .83
A) rapid heating (as in a microwave oven) to retain all nutrients
B) rapid heating (as in a microwave oven) to retain all immunologic factors
C) rapid heating (as in a microwave oven) to retain both nutrients and immunologic factors
D) gradual heating to retain both nutrients and immunologic factors
._______________ Celiac disease in an infant is best managed by .84
A) breastfeeding exclusively only briefly and early introduction of milk supplements and solids
B) breastfeeding exclusively only briefly, early introduction of milk supplements, and late
introduction of solids
C) breastfeeding as long as possible combined with early introduction of solids
D) breastfeeding as long as possible and late introduction of solids
._______________ If her mother smokes cigarettes daily, the infant is better off being fed .85
A) manufactured milk, to avoid ingesting nicotine-containing breastmilk
B) at the breast, to obtain the immunological protection of human milk
C) manufactured milk, to avoid being handled by a mother whose hands are frequently at her mouth
D) at the breast, because nicotine is inert in the infant’s system
._______________ An infant who is rooting typically .86
A) turns her head toward a stimulus
B) lifts her tongue to the roof of her mouth
C) purses her lips
D) makes licking movements
._______________ Lactation consultant advice and teaching can influence a client’s .87
A) age
B) previous infant-feeding experiences
C) social support
D) degree of formal education
._______________ A neonate’s visual abilities enable him to .88
A) focus on objects around 24 inches (60 cm) from his eyes
B) follow to the midline objects that move
C) converge his eyes
D) respond to stationary more than to moving objects
._______________ A tight lingual frenulum may be associated with .89
A) a heart-shaped indentation in the tip of the tongue
B) inability of the infant to gape widely
C) a short upper lip
D) extremely short jaw excursions during breastfeeding
._______________ A mother using medications to control her asthma should be .90
A) discouraged from breastfeeding because her medications pose a risk to the infant
B) encouraged to breastfeed because it may help protect her infant from asthma
C) discouraged from breastfeeding because of the energy drain on her system
D) encouraged to breastfeed only if she can discontinue her medications for the duration of
breastfeeding
When one assesses postpartum return of fertility, vaginal bleeding in the breastfeeding woman .91
._______________ in the early weeks following birth
A) indicates that her menses have returned
B) can usually be ignored unless it is very heavy
C) indicates that ovulation has occurred
D) indicates she has resumed sexual intercourse too soon
The lactational amenorrhea method of contraception can be relied upon for contraception .92
._______________ during the
A) first 6 months postpartum
B) first 9 months postpartum
C) interval in which the baby is taking at least two breastfeeds per day
D) entire course of any breastfeeding
Types of contraceptives for lactating women, in order from most preferred to least preferred, .93
._______________ are
A) estrogen containing, progestin only, nonhormonal
B) estrogen containing, nonhormonal, progestin only
C) nonhormonal, progestin only, estrogen containing
D) nonhormonal, estrogen containing, progestin only
Bromocriptine, which was once widely used to inhibit breastmilk production, is .94
.____________
A) still the drug of choice for reducing engorgement and inhibiting milk production
B) still the drug of choice for inhibiting breastmilk production, but not for reducing engorgement
C) no longer recommended because it is associated with serious cardiac problems
D) no longer recommended because it is associated with gastrointestinal perforation
Babies being introduced to soft table foods accept them more easily if the foods are .95
._______________
A) mixed with breastmilk
B) mixed with water
C) highly salted
D) cold
Evolutionary theory is a framework for research that proposes that human biological .96
._______________ phenomena
A) are fixed; their purpose or bodily benefit do not change with time
B) change rapidly (usually within a few generations) to meet changing human needs
C) may have developed to serve needs in the distant past that are less obvious today
D) are highly variable in their response to changing environmental conditions
._______________ One requirement of an experimental study is that .97
A) data are collected at the nominal (naming) level
B) no intervention is used
C) at least one independent and one dependent variable is used
D) study subjects may come from a convenience sample
._______________ Operational definitions explicitly describe .98
A) how equipment used in the study is to be used and maintained
B) how the major variables in the study are defined
C) the purpose for which instruments such as questionnaires were devised
D) the basic parameters of the study, such as number of subjects to be recruited and length of time
that subjects will be followed
Statistical analysis of the results of an experimental study that uses too small a sample size .99
._______________ may
A) not detect differences that actually exist between treatment groups
B) not detect apparent similarities that actually exist between treatment groups
C) reject the null hypothesis if an inverse relationship exists between independent and outcome
variables
D) reject the null hypothesis if a positive relationship exists between independent and outcome
variables
The MOST important reason for an LC to chart information about each contact with a client .100
:is to
A) provide information that is useful to other health-care workers
B) avoid legal claims against the LC
C) verify the LC’s time cards
D) substantiate the client’s insurance claims
._______________ A teachable moment refers to a moment when a learner .101
A) debates a point with the instructor
B) experiences an “A-ha!” moment during which new information is understood and assimilated
C) feels a need for new information or skills
D) is confronted by a situation in which she must instruct other learners
._______________ Skin-to-skin care (“kangaroo care”) can be safely begun with infants .102
A) only after they weigh at least 4 pounds, regardless of other medical problems
(“B) only after they weigh at least 4 pounds and have no major medical problems (are “growers
C) who are mechanically ventilated, even if they are very small
D) once they remain stable in their cribs
Which of the following would you suggest to a woman with inverted nipples during the third .103
?trimester
A) cut holes in the bra to allow the nipples to protrude
B) no intervention
C) use breast shells while awake
D) use Hoffman's maneuver four times a day
Which nutrition practice statement is true concerning a well-balanced diet for .104
?breastfeeding mothers
A) poor maternal dietary intake is a contraindication for breastfeeding
B) focus on high carbohydrate intake
C) consume mainly high protein foods
D)distribute food intake according to the food pyramid
The possibility of a lawsuit brought against an IBCLC can be reduced if certain .105
?practices are followed. Which of the following will reduce the likelihood of a lawsuit
A) Assume that you have permission to touch the mother and her baby at the outset of each client
.visit
B) Explain what procedures you wish to perform and what information those procedures will elicit,
.and ask permission to proceed
C) Be honest and direct in your discussions with the mother, even if it means making harsh
.statements
.D) Reveal the mother and baby’s identity if you discuss this case with other LCs
?Which of the following does NOT influence breastmilk composition .106
A) gestational age of a newborn
B) overall duration of lactation
C) the point (beginning or ending) of a feeding
D) maternal intake of water-soluble vitamins
:Hospital policies that promote breastfeeding include .107
A)encourage maternal rest to allow mother's milk supply to build up
B) unlimited access of mother to baby
C) use of a dropper for routine water supplementation
D) use of pacifiers to prevent sore nipples
As compared with households in which infants are bottle-fed, households in .108
._______________ which infants are breastfed are likely to experience
A) more household violence against women but not against children
B) less household violence against either women or children
C) more household violence against children but not against women
D) less household violence against women but not against children
When a second child joins a household consisting of a mother, father, and older .109
?sibling, how many relationships now exist between these four individuals
A) 3
B) 4
C) 6
D) 10
When is a discussion of infant feeding most effective in influencing a woman’s .110
?decision to breastfeed
A) after the baby’s birth
B) after the mother has returned home
C) during the prenatal period
D) after the father starts showing an interest in breastfeeding
After it is pumped, the ability of fresh, room-temperature breastmilk to kill bacteria is .111
._______________ highest
A) for about 45 minutes
B) for about 2 hours
C) for about 6 hours
D) for about 12 hours
.______________ A portion of thawed breastmilk that remains after a bottle-feeding .112
A) should be promptly refrigerated and used at the next feeding
B) may be layered on top of still-frozen milk and used as is convenient
C) should be discarded
D) may be left at room temperature if the next feeding will be within 3 hours
113. “Reverse cycle nursing” refers to _______________.
A) a breast pump’s cycling pattern that reverses the pressure exerted on the breast
B) an infant’s pattern of breastfeeding more at night and sleeping more during the day
C) breastfeeding on the weekend on the same schedule a mother uses when she is at work
D) breastfeeding just to the point of breast comfort to reduce a milk supply so that a mother
need not express milk on the job
According to the American Academy of Pediatrics, the new breastfeeding mother– .114
._____________ infant dyad should not be discharged before
A) the mother decides to go home
B) at least two breastfeedings have demonstrated coordinated suckling, swallowing, and
breathing
C) the baby has roused from his first long sleep on day 1
D) at least two feedings of any type have demonstrated coordinated suckling, swallowing,
and breathing
When a baby refuses to feed on one breast but will go to the other, the mother .115
._____________
A) should offer only the less-preferred breast
B) will need to use formula supplement to assure adequate infant growth
C) should express milk from the less-preferred breast
D) wait until the baby is very hungry, to increase the likelihood that she will feed from both
breasts
116. When would transitory nipple soreness be most noticeable?
A) between the first and second postpartum day
B) between the third and sixth postpartum day
C) between the sixth and tenth postpartum day
.D) any time in the first 2 weeks
On the basis of currently available (2004) growth charts, between 4 and 12 months of .117
._______________ age, fully breastfed infants generally weigh
A) about the same as formula-fed infants
B) more than formula-fed infants
C) less than formula-fed infants
D) less than formula-fed infants until solids are well established
Weight loss above _________ of birth weight and failure to regain birth weight by .118
._________ postpartum both require thorough assessment and intervention
A) 5 percent, 7 days
B) 10 percent, 8 days
C) 5 percent, 14days
D) 10 percent, 14 days
The main criticism concerning the US standard growth charts used before year 2000 .119
._______________ is that they were based on
A) less reliable statistical methods
B) a sample of infants most of whom were fed manufactured milks
C) a sample of infants from a variety of ethnic backgrounds
D) a sample of infants from a variety of locations in the United States
A breastfeeding mother with a 3-month old infant has a red tender wedge-shaped .120
area on the outer quadrant of one breast. She has flu-like symptoms and a
:temperature of 39° C. Your management includes all of the following EXCEPT
A) antibiotics for 10 days
B) extra rest
C) suspend breastfeeding for 48 hours
D) moist heat to the involved region
:The milk containing tubular structures under the areola .121
.A)are the lactiferous sinuses
B)are the milk ducts
.C)are supported with abundant adipocytes
.D) are dilated in a fusiform shape
 Look at the pictures and answer the questions

122. Which of the following behaviors is LEAST LIKELY to occur in the breastfeeding
child of this age?
a. Mother and child have a "code word" for breastfeeding.
b. Child can postpone nursing for short periods.
c. Nighttime breastfeeding increases child's risk of dental caries.
d. Child receives substantial immune protection from breastfeeding.
123. This mother of a 3-month-old began feeling pinpoint pain on her nipple tip 2 days
ago. The pain is MOST LIKELY due to a:
a. plugged duct.
b. plugged nipple pore.
c. bacterial infection.
d. sucking blister.
124. This mother's baby is 8 days old. The MOST LIKELY cause of the condition
pictured is:
a. normal breastfeeding.
b. baby is tongue-tied.
c. baby is not latching deeply.
d. baby is biting during feeds.
125. The bulge on this mother's breast is MOST LIKELY.
a. a plugged duct.
b. a galactocele.
c. mastitis.
d. an abscess.
126. After assessing this baby, your FIRST SUGGESTION to the mother should be:
a. Use a nipple shield during feeds.
b. Your baby needs an oral surgery consultation immediately.
c. Let's see how your. baby does at breast.
d. Pump your milk and feed with a bottle today.
127. This 8-day- old infant has been at breast constantly since birth. His mother
complains of nipple pain and states that her baby makes a clicking sound, and loses his
grasp of her nipple frequently during the feed. You have corrected her latch-on technique.
Your NEXT action should be:
a. Provide her with a sterile nipple shield.
b. Instruct her to use several different breastfeeding positions.
c. Instruct her in suck training to correct the baby's sucking.
d. Refer her to a health professional qualified to perform a frenotomy.
128. This condition is MOST LIKELY associated with which of the following?
a. delayed or inadequate treatment of mastitis
b. ductal yeast infection
c. transmission of oral bacteria from the babys mouth
d. bruising or trauma to the breast
129. What is the MOST LIKELY situation leading to this breast condition?
a. The child is over a year and using the mother's breast as a pacifier.
b. The mother did not wash her breasts after each nursing.
c. The child is biting during breastfeeding.
d. The child has an oral infection that was transmitted to the nipple skin.
130. What is the LEAST LIKELY cause of the condition shown?
a. Paget's disease.
b. Plugged nipple pore.
c. Persistent wound from baby's tongue thrust.
d. Nipple thrush.
131. You would recommend this technique for all of the following EXCEPT.
a. premature baby
b. separation of mother and baby for any reason
c. mother taking a contraindicated medication
d. mother has a history of sexual abuse
132. This mother's nipple pain has persisted for over 2 weeks. You would check her baby
for all of the following conditions EXCEPT:
a. micrognathia.
b. short lingual frenulum.
c. tongue thrust movements.
d. cleft of the soft palate.
133. This baby prefers this position and has significant difficulty nursing in other
positions. What is the MOST LIKELY cause of this preference?
a. interesting objects on one side of his crib
b. mother feeds only on one breast
c. torticollis
d. ankyloglossia
134. The mother of this infant is MOST LIKELY to complain of:
a. difficulty getting baby to latch on.
b. itching, burning nipples.
c. vaginal discharge.
d. plugged ducts.
135. This mother is 4 days postpartum. All of the following recommendations are
appropriate EXCEPT:
a. Apply cool cabbage compresses to the lump in your right armpit.
b. Feed your baby at least every 2 to 3 hours or more often if he cues.
c. Apply hot compresses to help milk flow in your left breast.
d. Use cool compresses after feeds if breasts feel full.
136. This breastfeeding child lives in a northern latitude. To prevent rickets, you would
recommend all of the following EXCEPT:
a. Expose the child's face to sunlight for 20 minutes every day.
b. Mother should take a vitamin D supplement.
c. Mother should expose her face and head to sunlight for 2 hours a week.
d. Give the child a vitamin D supplement regardless of symptoms.
137. This child has recently begun solid foods. Based on the condition pictured, she is
likely to also have any of the other reactions listed below EXCEPT
a. wheezing.
b. colic.
c. sleepiness.
d. irritability.
138. This baby's behavior as shown is MOST LIKELY to be caused by:
a. overfeeding at breast.
b. too-vigorous burping after feeds.
c. allergy to something in mother's diet.
d. gastroesophageal reflux.
139. The mother of this baby is practicing the Lactation Amenorrhea Method of family
planning. Which behavior would NOT diminish the effectiveness of the method?
a. intercourse more than twice a week.
b. relief bottle every other day.
c. baby sleeping through the night
d. return of menstruation
140. This baby feeds for 30 to 45 minutes at each breast, each feeding, in the exact
position shown in this picture. The MOST LIKELY cause of this behavior is:
a. normal behavior
b. disorganized sucking
c. mother has low milk supply
d. delayed clearing of labor drugs
141. What is the MOST LIKELY conclusion you could draw from the appearance of this
lactating woman's breasts?
a. The smaller breast has insufficient glandular tissue.
b. The larger breast is making much more milk than the smaller.
c. The baby most recently nursed on the smaller breast.
d. Lactation and breastfeeding are proceeding smoothly for her and her baby.
142. What is the MOST LIKELY age of this baby?
a. 36 weeks gestational age
b. 38 weeks gestational age
c. 2 days postbirth
d. 4 days postbirth
143. All of the following will improve this mother's breastfeeding success EXCEPT:
a. wearing breast shells several hours a day for the remainder of her pregnancy.
b. learning nonpharmaceutical methods of pain relief for labor.
c. vigorously pulling and stretching her nipples several times a day.
d. arranging for 24-hour rooming-in starting at birth.
144. The condition pictured appeared suddenly 3 days postbirth. The FIRST suggestion
you would give to this mother is:
a. Try massaging the plug of milk toward your nipple.
b. See whether the lump changes size after you nurse your baby.
c. Put hot compresses on the swollen area.
d. Make an appointment with a breast surgeon for a biopsy.
145. When would this mother's baby get milk with the highest fat content?
a. the last 5 minutes of each feed on either breast
b. after nursing several times on one breast
c. in the middle of the night
d. when mother is eating a high-fat diet
146. This mother asked for advice on family planning. She wishes to continue
breastfeeding yet does not want to become pregnant again. Your BEST response to her is:
a. Begin taking a progestin-only oral contraceptive.
b. Use a condom every time you have intercourse.
c. An intrauterine devise is your best option.
d. Breastfeed exclusively around the dock without supplements or pacifiers.
147. What is this mother doing with the hand that is not holding the device?
a. tapping the breast to aid milk let-down
b. massaging milk toward the nipple to increase collected volume
c. pressing her breast more deeply into the flange
d. stroking the skin surface to increase milk synthesis
148. The rash on this babys face appeared when he began receiving supplements of cow's
milk-based artificial baby milk. What is the MOST LIKELY cause of the rash?
a. normal infant acne
b. reaction to nonhuman protein in the artificial baby milk
c. presence of bovine antigen in mother's milk
d. allergic reaction to latex in bottle teat
149. What is the MOST LIKELY reason this baby cannot make a good
seal on the mother's breast?
a. The tongue is trough-shaped.
b. The tongue is too thick.
c. The baby has a small mouth opening.
d. The lingual frenulum is short and tight.
150. This baby's mother complains of clicking and smacking during breastfeeds. The
MOST LIKELY explanation is:
a. high-domed palate prevents deep latch.
b. tongue-tie prevents deep attachment.
c. tongue shape causes intermittent loss of seal.
d. buccal fat pads are interfering with tongue movement.
151. This mother's baby was tongue-tied and was having trouble latching on and
breastfeeding. The MOST LIKELY maternal reason for the baby's difficulty is:
a. her nipple is somewhat short and flat.
b. her breast is engorged, preventing deep latch.
c. her nipple is very small, and the baby couldn't feel it.
d. her nipple is very large, and the baby was choking on it.
152. The baby's tongue was pressing this mother's nipple against the baby's hard palate.
Which cranial nerve was MOST responsible for this tongue movement?
a. spinal accessory
b. vagus
c. hypoglossal
d. trigeminal
153. The lumps on this woman's areola are MOST LIKELY due to which of the
following?
a. irritation from wet bra pads
b. infected Montgomery glands
c. poison ivy
d. normal anatomy
154. This mother is concerned about the condition shown in this picture. Which of the
following is the MOST APPROPRIATE response?
a. You may have Reynaud's syndrome. Keep the room warm when you breastfeed.
b. The lumps are Montgomery glands, which help lubricate the skin. They're normal.
c. This appears to be an allergic reaction. Did you recently start wearing a new bra?
d. May I check your baby's mouth to see if he has a thrush infection?
155. The nipple shown in this picture is:
a. inverted.
b. retracted.
c. folded.
d. flat.
156. This woman is planning to become pregnant. She is concerned about her nipple size
and worried that her baby will have difficulty breastfeeding. Your BEST response to her
is:
a. Yes, your small nipple may be a problem.
b. Small nipples work just fine-in fact, they may make breastfeeding easier
c. Be sure to pull and roll your nipples daily throughout pregnancy
d. Wear breast shells during your pregnancy to increase eversion
157. When a breastfeeding baby has this condition, the FIRST thing you would do is:
a. treat the baby and mother's breast for a fungal infection.
b. check the child for other manifestations of allergic responses.
c. advise the mother to change the baby's diaper more frequently.
d. have the mother apply a cortisone ointment on the rash.
158. What is the MOST LIKELY cause of the condition pictured?
a. acidic urine from human milk feedings
b. yeast infection (candida)
c. allergic reaction to cow milk protein passing through mother's milk
d. sensitivity to chemicals in disposable diapers
159. After examining this woman's breasts, you would do all of the following actions
EXCEPT.
a. instruct her on better cleaning procedures for her breast pump.
b. provide her with a nipple shield to wear during feeds.
c. request that the primary care provider culture the baby's mouth.
d. recommend that she wean immediately.
160. About how much milk will this baby receive each day during the next week if
breastfeeding is not restricted?
a. The baby gets about 150 ml/day (5 oz/day) of colostrum.
b. The baby gets increasing amounts each day as milk volume increases.
c. The baby needs a supplement until day 5 when mom's supply is sufficient.
d. The baby gets 750 ml/day (25 oz/day) from day 2 onward.
161. Offering this child family (complementary) foods in addition to breastmilk is
appropriate at this age for all of the following reasons EXCEPT
a. she is about 6 months old.
b. she is reaching for table foods.
c. the nutritional quality of mother's milk is diminishing.
d. she enjoys the social aspects of family mealtimes.
162. Breast shells would be MOST helpful for this mother to
a. evert her nipples.
b. protect the damaged skin from clothing.
c. protect the nipple tip from the baby's palate.
d. reduce areolar edema.
163. The equipment shown in this picture is appropriately used for all of the following
EXCEPT
a. inducing lactation when the baby is adopted.
b. supplementing a neurologically impaired baby at breast.
c. correcting a baby's dysfunctional sucking pattern.
d. aiding the mother to reestablish breastfeeding after an interruption.
164. This mother complains of sharp nipple pain. Your suggestions should include all of
the following EXCEPT.
a. apply purified lanolin to the irritated area.
b. wear a silicone nipple shield during feeds.
c. wear breast shells between feeds.
d. bring the baby deeply onto the breast.
165. This device should have all of the following-features EXCEPT.
a. can cycle 40 to 60 times per minute
b. creates vacuum pressure in the range of 100 to 300 mm Hg
c. flange diameter easily accommodates the mother's nipple
d. requires sterilization after every use
166. Which is the LEAST appropriate treatment for this condition?
a. antifungal therapy
b. infant continues to breastfeed
c. fit mother with a breast binder
d. antibiotic therapy
167. This mother is worried that her left breast is larger than her right. Your FIRST
response should be:
a. the left breast appears to have mastitis.
b. different breast sizes are very common.
c. what size were your breasts before pregnancy?
d. the left will clearly make more milk than the right.
168. This mother says her nipples started itching and stinging a few days ago. The MOST
LIKELY cause of her symptoms is:
a. dry skin.
b. eczema.
c. Nipple thrush.
d. positional soreness.
169. Which of the following suggestions is MOST LIKELY to be helpful for the
condition pictured?
a. Air-dry after feedings.
b. Expose the breast to a sunlamp placed about 1 ft (0.3 m) away.
c. Use moist wound healing techniques or preparations.
d. Cover with a breast shell between feeds.
170. This baby had trouble latching and staying on breast and was not gaining weight.
The mother's nipples were very painful at every feed. Attempting a deeper latch and better
positioning did not improve the situation. The practitioner shown is MOST LIKELY
performing which of the following procedures?
a. frenectomy
b. frenotomy
c. tonsillectomy
d. myringotomy
171. Which visual aspect of this baby's latch is LEAST LIKELY to be a problem?
a. angle of the lips/mouth is about 90 degrees
b. puckering along the naso-labial crease
c. chin barely touches the breast
d. areola is nearly completely in babys mouth
172. This baby's mother is concerned about a clicking, smacking sound that occurs during
nursing. Her nipples are mildly tender. Your FIRST intervention would be:
a. Refer her for evaluation of the baby's tongue musculature.
b. Assure good alignment and deep latch at breast.
c. Perform a digital exam to assess tongue movement.
d. Reassure her that some nipple tenderness is normal in early lactation.
173. This mother has not completed State III of her labor. Her baby is healthy. The NEXT
thing you should do is:
a. get her to a hospital.
b. put the baby to breast.
c. give her oxygen for her exhaustion.
d. have her assume a supine position.
174. This mother's baby is four months old. The MOST IMPORTANT thing you would
do to help relieve this mother's discomfort is:
a. teach her how to keep her baby from squirming during feeds.
b. assist her baby to take more of the breast during latch-on.
c. provide a silicone nipple shield to reduce abrasion on the nipple skin.
d. help her get treatment for a probable nipple thrush infection.
175. This ccndition began when the child started taking solid foods. What would your
FIRST management strategy be?
a. Discontinue all solid food until the rash clears up.
b. Mother should stop consuming dairy products.
c. Take a thorough history of the mother and baby's food intake.
d. Refer the dyad to a dermatologist.
176. This mother's baby is 20 hours old and has not yet effectively latched or, and
breastfed. What would be your FIRST strategy to help them?
a. Place a silicone nipple shield over her nipples during feeds.
b. Have the mother pump her breasts to firm and evert the nipple tissue.
c. Remove her clothing and place the baby skin-to-skin on her chest.
d. Suggest she begin suck training to coordinate the baby's suck.
177. This mother complains of pinpoint pain at the 1:00 position on her nipple. Your
FIRST suggestion to her would be:
a. use a sterile instrument to lift the flap of skin over that pore.
b. soak the nipple tip in warm water, then try to "pop" out the plug.
c. coat the nipple with an antifungal preparation.
d. nurse frequently on that side as often as the baby is willing
178. How would you document this baby's oral configuration?
a. Normal tongue position.
b. Tongue is bunched or humped.
c. The tongue stays behind the inferior alveolar ridge.
d. The baby has a poor tongue position.
179. This baby feeds at least 10 times a day, including 2 to 3 feeds at night. Her
grandmother has advised her mother that she should be feeding her rice cereal and
strained fruits. Your BEST response to her is:
a. This frequency of feeding is normal for a baby of this age.
b. If she has been nursing this frequently for several days, then you apparently cannot
make enough milk for her.
c. She does not need solids, but she should be sleeping through the night.
d. If she is 4 months old, it is good to start her on supplemental foods.
180. This mother is 36 weeks pregnant. Your BEST recommendation would be:
a. rub your nipples with a towel twice a day.
b. be sure to breastfeed in the first hour post-birth.
c. pull and roll the nipple to stretch it.
d. you wouldn't be able to breastfeed.

181. What technique is being shown in this picture?

a. checking for cleft palate
b. suck training
c. digital oral assessment
d. checking for short frenulum
182. This baby's mother complains about clicking and smacking during breastfeeds that
has continued since the baby was a newborn. She has just begun taking solid food. The
FIRST action you would do is:
a. check for a cleft of the soft palate.
b. observe a full breastfeeding session.
c. have the baby’s doctor diagnose or rule out thrush infection.
d. ask the mother to record what foods the baby has taken in the past 24 hours.
183. What is the FIRST thing you would recommend to increase this mother's comfort
during breastfeeding?
a. Bring the baby further onto the breast.
b. Use an antifungal cream on her nipples.
c. Apply lanolin after nursing.
d. Use a different brand of bra pad.
184. Compared with the NCHS growth charts, this child gained weight faster than
expected in her first three months, but now is slightly below the same percentile curve.
All other development milestones are normal. Your BEST recommendation to his mother
is:
a. Continue what you are doing. His growth pattern is normal for breastfed babies.
b. Begin feeding him more solid foods to increase his weight.
c. Take away his chewing toys and pacifiers as they are distracting him from eating.
d. Supplement with a cow's milk-based infant formula because he needs more calcium,
for growth.
185. This mother just finished pumping her milk. The MOST LIKELY explanation for the
condition pictured is:
a. nipple thrush.
b. pump flange was too small in diameter.
c. Reynauds’ phenomenon.
d. pump has everted her nipples.
186. This mother is likely to experience all of the following EXCEPT:
a. mutual enjoyment of breastfeeding.
b. sibling rivalry for the breast.
c. babies interact with each other during feeds.
d. higher risk of milk stasis.
187. This mother is becoming annoyed with her child's behavior during nursings,
including the action shown in the photo. Your FIRST response to her should be:
a. Well, then it's time to think about weaning him.
b. Many children try to nurse while they play with toys.
c. Driving his toy truck across your chest during nursing really bothers you.
d. Grab his hand and don't let him play with your body during feeds.
188. Mother support groups are MOST effective for which of the following reasons?
a. Groups meet in members' homes.
b. The group leader is highly trained.
c. Cost for support groups is usually low.
d. Mothers hear other mothers' ideas.
189. Which is the LEAST LIKELY reason this child breastfeeds 4 to 8 times every day,
including 1 to 2 times at night?
a. Mother is pressuring the child to gratify her own desires.
b. Child is recovering from gastroenteritis.
c. Child is allergic to many foods.
d. Mother is recovering from a hospital stay where child could not visit.
190. This breastfed baby's mother feels that he should learn how to sleep for at least 8
straight hours at night. Your BEST response to her is:
a. Most babies of this age still need to breastfeed around the clock.
b. He is too young now, but he should be sleeping through the night soon.
c. If you don't go to him for a few nights, he will learn to sleep longer.
d. He does not need to breastfeed at night if he weighs at least 12 lbs. (5.4 kg).
191. The age of this baby is MOST LIKELY
a. 4 months.
b. 6 months.
c. 8 months.
d. 10 months.
192. The support being received by this mother helps foster all of the following
EXCEPT-
a. improved maternal-infant bonding.
b. breastfeeding duration.
c. maternal self-esteem.
d. increased maternal dependency.
193. Common breastfeeding behaviors of babies at this age include all of the following
EXCEPT:
a. mother and baby develop "Code word" for nursing.
b. baby is taking family foods well.
c. increased ability for baby to postpone feeds.
d. baby passes stool during most feeds.
194. Which of the following events are NOT associated with a baby of this age?
a. Breastfeeding is going smoothly.
b. Baby sleeps 8 to 9 hours at night.
c. Baby looks to locate interesting sounds.
d. Baby recognizes mother and smiles.
195. Which statement BEST describes the reason this baby would begin reaching for
table (family) food?
a. The baby is developmentally ready for solid food.
b. The mother's milk supply is no longer adequate.
c. The baby is just imitating and will not be ready for family foods for some time.
d. The baby is jealous because everyone else is eating "real food."
196. Which of the following is the MOST common breastfeeding behavior of a child at
this age?
a. Biting at the end of feeds.
b. Nursing strike.
c. Easily distracted while nursing.
d. Playfulness and vocalization during feeds.

197. This baby's mother complains that her baby has increased her night feeds. Your
responses should include all of the following EXCEPT:
a. this is normal behavior at this age.
b. try going to a quieter, darker place.
c. you can try feeding solid foods during the day.
d. night feeds are important to your baby at this age.
198. The infant behavioral state shown in this picture is:
a. active alert.
b. quiet alert.
c. light sleep.
d. drowsy.
199. This child's nursing behavior is:
a. highly unusual at this age.
b. indicative of attachment disorder.
c. normal for a child this age.
d. likely to cause dental caries.
200. What is the LEAST LIKELY reason that a grandmother would engage in the
behavior shown?
a. competition with the baby's mother.
b. soothe the baby while mother finishes a nap.
c. baby has a medical condition that require upright posture.
d. genuine affection for her grandchild.