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Test-Taking Strategies:
Keys for Lactation Exam Success
A Self-Learning Package
by Marie Biancuzzo, rn ms ibclc
Test-Taking Strategies: Keys for Lactation Exam Success
Copyright 2006
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means without prior written permission of
the publisher.
The most recent version of this document may always be obtained at
www.breastfeedingoutlook.com
Breastfeeding Outlook
Box 387
Herndon VA 20172-0387
www.breastfeedingoutlook.com
ISBN # 978-1-931048-06-4
Note: The number of contact hours may increase or decrease slightly when the packages are
re-approved, as required by our approval agencies. Check our web site at
www.breastfeedingoutlook.com for updates.
Preface
Preparing for a comprehensive exam is one of the most
daunting endeavors I’ve ever undertaken. When I am
preparing, I am sometimes rather overwhelmed by two
thoughts: I can’t possibly remember everything and I haven’t
studied everything I need to have studied.
I can’t possibly remember everything I’ve ever learned about
the topics on the exam. Yet, I know it is a comprehensive
exam, which, by definition, means that anything I’ve ever
learned is fair game. The thought of reviewing–far less
actually remembering—all of the information that I’ve
accumulated over several years is enough to set my head
spinning.
At the same time, I realize that identifying, reviewing, and re-mastering the once-learned
information actually may be the easy part. The hard part seems to be wading into a
comprehensive exam that is complete, far-ranging, broad-based, and virtually limitless in
its scope. There very well may be test items that address sub-topics about which I have
little or no knowledge. I worry that if I didn’t know something existed, I didn’t study it;
therefore, I can’t possibly pass the exam. Or can I?
While I was developing the syllabus for Marie Biancuzzo’s Lactation Exam Review course,
I realized that I couldn’t possibly teach participants everything they need to know to pass
a comprehensive lactation exam. I couldn’t cover all the topics that might be on the exam
or infuse them with all of the facts they might need to know to pass the exam. However,
I could teach them how to prepare or the exam, how to correctly write down what they
actually do know, and how to figure out a correct response when they might not have
mastered the material being tested.
This self-learning package came about because there is not enough time in the course
schedule to address some of the finer points of preparing for and passing a comprehensive
lactation exam. In teaching people how to prepare for and take the exam, I’ve given up on
the idea that I can teach everything about a topic, even one I know as well as lactation.
Instead, I’ve come to espouse the idea that, as test-takers, we need to learn the basics
about the topic and apply those basic concepts to actual test items.
I hope that this short learning package will help you become a better test-taker.
Instructional Objectives
• Plan how to get to the exam site and avoid last-minute snags.
• Describe general study strategies for preparing for a comprehensive exam.
• Describe how to effectively prepare for items on the IBLCE exam.
• Describe how to correctly select correct options when taking the IBLCE exam.
• Given one of the 4 types of distracters, use effective strategies for selecting the right
answer.
• Recognize and avoid the pitfalls of photo items.
• Describe specific techniques for selecting correct responses when you know the
material, when you are uncertain, and when you are completely stumped.
Audience
This self-learning package is appropriate for:
• Staff nurses
• Advanced practice nurses
• Dietitians
• Lactation consultants
• Childbirth educators
• Others preparing for the IBLCE exam
Table of Contents
PRE-TEST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
MASTERING THE MUNDANE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Site Details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
When. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Where. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
What to Bring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
How Much. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Last-Minute Snags. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PREPARING FOR A COMPREHENSIVE EXAMINATION. . . . . . . . . . . . . . . . . 2
Study Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
What to Expect on the Exam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Examination Itself. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Frequently Asked Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
HOW MULTIPLE-CHOICE EXAMINATIONS ARE CONSTRUCTED. . . . . . . . 6
Components of Each Item. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Stem. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Types of Multiple-Choice Items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Recognition and Recall Items. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Call to Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Graphics Interpretation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Types of Distracters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Outdated Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
“Echo” Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sounds Like. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Looks Like. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
TACKLING THE IBLCE EXAMINATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
When You Know the Answer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Read Carefully; Write Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Answer the Easy Items First. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Note the Qualifiers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Stick With Your First Answer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
When You Feel A Little Uncertain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Bolster Your Powers of Recall. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Deal with Distracters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
When You Are Completely Stumped. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Guess! You Might Be Right!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
OKAY, YOUR TURN!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
REFERENCES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
APPENDIX A: PRACTICE QUESTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
APPENDIX B: KEY FOR PRACTICE QUESTIONS. . . . . . . . . . . . . . . . . . . . . . 33
APPENDIX C: IBLCE EXAM BLUEPRINT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
APPENDIX D: AGENDA FOR EXAM DAY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
APPENDIX E: BOOKS THAT HELP YOU TO PREPARE FOR EXAMS . . . . . . 35
POST-TEST. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
POST-TEST ANSWER SHEET. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
EVALUATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
ORDER FORM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Pre-test
Mark each of the following as TRUE or FALSE:
1. You are penalized for guessing on the IBLCE exam.
2. You are not allowed to make stray marks on the exam booklet.
6. The entire examination consists of 200 items, most with 4 options but some with 3
or 5 options.
8. The passing score on the IBLCE exam varies from one year to another.
10. The items that use the LEAST language are all grouped together on the IBLCE exam.
Answers: 1. False, 2.False, 3. False, 4. False, 5. True, 6. True, 7. True, 8. True, 9. True, 10. True
!
Before you do anything too fancy to prepare for the exam, you will need to master the
mundane. However boring it may be to do, you will need to look up site details, write
them down, and use some simple strategies to reduce last-minute snags.
Last-Minute Snags
• I f you have any questions, call IBLCE as many days before the test day as possible.
IBLCE’s phone number is 703-560-7330. Better yet, save yourself the cost of a long-
distance call and the time you’d spend waiting on hold. Visit the IBLCE web site at
www.iblce.org. Many of the most common questions are answered there.
• ind the exam site several days before the exam. Be sure that you are confident that
F
you can drive the right roads, take the right trains, etc. Make sure that you know how
long the trip will take at the particular time of day you will be traveling.
• S everal days before the exam, ask a friend if he or she will be able to give you a lift if
your car won’t start or if you encounter some other transportation problem on the
day of the exam.
• S et two alarm clocks. If you think there’s a chance you might sleep through both of
them, ask a friend to call you on the phone at the time you’d need to get out of bed
on exam day.
• on’t drink too many cups of caffeinated coffee or soft drinks before the exam. The
D
IBLCE is a timed exam, and you’ll waste precious time getting up and going to the
restroom. Also, one of the proctors will be required to escort you each time you go,
so if it bothers you to know that someone will be hearing you tinkle, reduce your
caffeine intake to eliminate or reduce potty-stops during the exam.
• llow plenty of time to get to the exam site and park. If you’re running behind, you’ll
A
be a nervous wreck before you even sit down in the exam room. On the other hand,
if you’re a little early, you can always spend a few minutes going over your notes.
When
Date of the IBLCE Exam:_ ____________________________________________
Registration is at:______________________________________________ o’clock.
Exam starts at:________________________________________________ o’clock.
If I am late, the consequence is:_________________________________________
Where
Address:___________________________________________________________
Name of Building:___________________________________________________
Where to Park:______________________________________________________
Other transportation notes:_ ___________________________________________
_________________________________________________________________
_________________________________________________________________
What to Bring
Three things to bring to the exam are:
1.)_ ______________________________________________________________
2.) _______________________________________________________________
3.) _______________________________________________________________
How
How do I get there? (Look at a map and figure it out. Or, visit www.mapquest.com or
www.mapsonus.com. and enter the address you will start from on the morning of the
exam and the address of the test site.)
How Much
How much will it cost for parking and tolls?
Will I need exact change to get through any toll booths along the way? How much?
Will I need money for lunch? How much?
Study Strategies
To some extent, the study strategy or strategies that you select will depend on your own
learning style. Some people learn best by studying alone; others learn best by studying
with a partner or a group; still others learn best by combining these two strategies.
A variety of study strategies can be employed, and the strategies you use should be
determined by the type of information you need to master. For the IBLCE exam, you
need to know basic facts and terminology, methods and procedures for using equipment,
and concepts and principles that guide breastfeeding and lactation management
throughout the childbearing cycle.
After you have mastered the basic knowledge, you’ll need to be able to apply it. Most
of the exam items will focus on application; that is, they will require you to use your
knowledge and comprehension of a topic in order to identify what action should be
taken.
Study strategies will be discussed in more detail later in the learning package. Meanwhile,
you’ll need to get a basic grip on what to expect on the IBLCE exam.
break for lunch. In the afternoon, you will have 3 hours to answer 100 items, 75 of which
will involve photos and 25 of which will be text-only. That means that in the morning as
well as in the afternoon, you can allow yourself only a little less than 2 minutes for each
item. This doesn’t mean that you should watch the clock anxiously or check it after each
item. What it does mean is that you should plan your test-taking approach so that you
can make the most of your limited time.
Text-only Items
There are 125 multiple-choice, text-only items. Most of the items ask you to select your
response from 4 options. Occasionally, 3 or 5 options will be available.
Photo Items
There are 75 items for which you will look at a photo in order to choose your answer. In
years past, the photos were presented as slides flashed on a screen, but that’s no longer the
case. When you take the exam, you will receive your own booklet of photos. Each photo
will be numbered to match the corresponding item in the exam booklet.
Time in Relation to Format
If you’re like me, it will take you longer to answer the photo items than to answer the
text-only items. Therefore, in the afternoon, I buzz through all of the text-only items first,
so that I can devote the remaining time to the photo items. Otherwise, I’d be obsessing
over the photo items, and I might not leave myself enough time to answer all of the text-
only items.
not you will be penalized for guessing. In the case of the IBLCE exam, you will not be
penalized for guessing. Therefore, even if you really don’t know the answer, you should
mark a response. In that case, you should guess.
The Stem
The stem is the first part of the test item. It contains the information on which the
question is based. Stems come in three formats: (1) the simple question, (2) the partial
sentence (sentence fragment), and (3) the best answer.
The simple question format is a good one because the stem expresses a complete thought.
By reading the simple question, you are immediately able to start formulating a response
in your head, and perhaps even before you read the options, you know that the answer s
c) Ronald Reagan.
all of the others. Variations of this format include such constructions as “the first
action,” “the most important,” “the primary reason,” and “the least likely.” Here’s an
example of the “best answer” format:
Which of the following is the best utensil for eating yogurt?
a. knife
b. spoon
c. fork
Heaven knows, if you’re clever and patient, you could probably load your yogurt
onto a knife and eat it that way. I cheerfully admit that I’ve eaten yogurt with a fork
when I’ve been on the road and that was the only utensil I had with me. But the best
utensil for eating yogurt is, clearly, the spoon.
Okay, are you in the groove of this? Now take a look at a “first action” question:
In the morning, which of the following would you do first?
a. take a shower
b. shut off the alarm
c. grab your keys
d. get dressed
You probably do all of these things. But the item asks which action you would do
first. There are several simple strategies you can use to answer this item correctly.
The first thing you should do is to focus on the word first! Underline it. Honestly, so
many people blow right by that word, then get befuddled trying to figure out which
actions they would do and which they would not do. Indeed, the item acknowledges
that all of these actions are appropriate morning activities; it only asks which would
be done first. Okay, so let’s say you didn’t know how to answer this. With some
simple logic, you could figure out that it would be annoying to hear the alarm clock
buzzing while you’re in the shower. You could reason that a person wouldn’t take a
shower after putting on clothes. It’s certainly possible to grab your keys while you’re
still in your nightgown or naked, but would you? Probably not. As you study for the
exam, practice walking yourself through items in this manner when you’re uncertain
about the order of the actions.
Okay, now let’s tackle those pesky “least” constructions. I don’t like taking tests with
this construction, and frankly, I don’t write items with it. IBLCE does, so let me show
you what they are and how to effectively deal with them.
Here’s an example from the 2004 IBLCE Candidate Guide:
After several years of planning, a hospital will be implementing a new
breastfeeding protocol. Which of the following components of the protocol is
least likely to promote breastfeeding success?
a. early initiation of breastfeeding
b. progressive lengthening of time at breast
c. nighttime breastfeeding
d. supplementation, if medically indicated
If you are like me, you may get all tangled up in this item. To effectively deal with
it, force yourself to scribble no, yes, or maybe next to each option. In fact, let’s do
that right now. Will early initiation of breastfeeding promote breastfeeding success?
The Options
Following the stem, there are several options. Usually, there are 4 options, but
occasionally there are 3 or 5 options. Among these options, you’ll find only one
correct answer; the other options are called distracters. Qualifiers in the options are
important to note, as they often provide valuable information.
The Distracters
Distracters are the incorrect options. They are designed to be similar to the correct
answer. Here’s an example of an item followed by the correct answer and 3 options
that are similar:
The president who called himself a “compassionate conservative” is
a. George H.W. Bush.
b. George W. Bush.
c. Ronald Reagan.
d. Abraham Lincoln.
In this example, all of the options are Republican presidents. Option (d) is an
enticing distracter because Abraham Lincoln freed the slaves; thus, he might be
thought of as compassionate. Option (c), Ronald Reagan, was a central figure
in calling for the removal of the Berlin Wall; thus, he might be thought of as
compassionate. But perhaps you know that the answer is neither Reagan nor Lincoln.
You know it was one of the Bush presidents, but you can’t remember which one. In
that case, option (a) is a very effective distracter because it is so similar to option (b),
which is, of course, the correct answer. A good distracter is one that is very similar to
the right answer.
!
example, when I teach my review course, I teach participants a kinesthetic cue to
help them remember the locations of the milk lines. I show the lines in a photo,
and then I ask participants to poke their own bodies in those seven places where the
supernumerary nipples are likely to appear along the galactic band. Participants have
told me that feeling those pokes helped them to remember where the milk lines are
when they have encountered the topic on the exam. Mnemonics
Mnemonics
Mnemonics are memory tricks. The most common type of memory trick is the
are memory
acronym, a word that is created by using the first letter of each of the key words. For
example, a popular tool for remembering the names of the five Great Lakes is the
tricks.
acronym “HOMES,” which stands for Heron, Ontario, Michigan, Erie, and Superior.
Other mnemonics use the first letter of each word to be memorized, but substitute other
words to form a memorable sentence. In health care, a popular mnemonic is used for the
12 cranial nerves: On Old Olympus Towering Tops, a Finn and German Viewed Some Hops.
This memory trick reminds the learner of the olfactory, optic, oculomotor, trochlear,
trigeminal, abducens, facial, acoustovestibular, glossopharyngeal, vagus, spinal accessory,
and hypoglossal nerves.
I learned that mnemonic when I was in a biology class more than 30 years ago, and I can
still repeat it, as well as the names of the nerves it helps me to remember! Interestingly,
when I took the IBLCE exam, I had to repeat this mnemonic to myself in order to answer
one of the items.
Rhyming words are also mnemonics. Did you ever have trouble opening an oxygen
tank? One night, I was working in the operating room and I needed to use the portable
oxygen tank. The patient’s status was critical, and I was nervous. The oxygen tank was
closed very tightly, and as I turned it, I couldn’t tell if I was opening it or closing it. Then,
I remembered the tip my father had told me about opening jars and other household
items: “Righty tighty, lefty loosey.” Sure enough, turning to the left opened the oxygen
tank. Another example of a rhyming mnemonic is Dr. Marianne Neifert’s advice for
managing mastitis: “Heat, rest, empty breast.” If you need to answer an exam item about
managing mastitis, this mnemonic may prove to be very helpful. With a little thought,
you can probably make up your own mnemonics for those topics that you find difficult to
memorize.
!
and can you list several of its signs and symptoms? If not, you’re going to have difficulty
answering more complicated items that require you to take action in response to the
condition.
To me, the most basic skill of word knowledge is learning the Latin or Greek prefixes,
roots, and suffixes. More than 90% of words in a medical dictionary have Latin or Greek More than
derivations. If you were asked to look at a diagram and identify the pterygoid muscles,
it would help to know that the Greek word pterygodes means wing. Armed with that 90% of
knowledge, you’d immediately recognize these wing-shaped muscles, which are used when
the infant suckles. Best of all, you’ll have some clue about what a word means even if words in
you’ve never seen it before. The longest word in Gould’s Medical Dictionary is Hepati-
cocholangiocholescystenterostomies. With a good understanding of ancient derivations, you a medical
could break this up into hepato-cholangio-cholescyst-entero-stomies and immediately
know that it means the surgical creation of connections between the gall bladder and the dictionary
hepatic duct, as well as the intestine and the gall bladder. As you can see, this skill can
be very handy during an exam when you are faced with a word you don’t know. If you have Latin
don’t have a clear command of the Latin and Greek prefixes, roots and suffixes associated
with biology, chemistry, medicine, surgery, and pharmacology, you need to develop or Greek
your knowledge in this area, pronto. It’s fairly easy. Flash cards are an excellent tool for
mastering this material. derivations.
Here’s an example of an item that you could answer correctly only if you knew the
definition of the key word used:
Which of the following composers wrote impressionistic music?
a. Fauré
b. Debussy
c. Poulenc
d. Foucault
If you don’t know what the word “impressionistic” means, you’re sunk. If you know
anything about Impressionism, you probably can answer the item. Impressionism
was a style of art and music that predominated in France in the late 19th and early
20th century, so knowing which of these men lived during that time would help.
Also, if you know that Impressionism relies on rich tones and harmony rather on
than structure and form, and if you are familiar with the works of Fauré and Poulenc,
then you can eliminate them from your options. In addition, if you know that
Impressionistic music used its lack of form to express emotion or depict scenes, you
can pick the right answer. Most of this information is based on a good definition
of Impressionism. Only one of the above-named men wrote music with the floaty,
fragile, formless feeling of Impressionistic music. You’ve heard “Claire de Lune” a
million times, and that piece epitomizes Impressionism. In fact, even if you didn’t
know anything at all about Debussy except that “Claire de Lune” was one of his most
famous pieces, your recall of the melody might help you to pick the right answer.
If you knew that Impressionism was based in France, and you recalled the “Claire
de Lune” title, you might also be able to pick out the correct answer. Finally, if you
knew that Foucault was a scientist, you would be able to eliminate option (d) right
off the bat!
Normal Parameters
If you don’t know what’s normal, you won’t know whether you should take an action
or simply stand by and observe. For example, in order to know if a baby has achieved
adequate weight gain at 1 month, 6 months or 1 year, you would need to know the
weight gain that infants are expected to achieve at each of these milestones. Now don’t
laugh, but I’m going to take you out of the clinical area and into the kitchen for a
moment in order to demonstrate the importance of knowing normal parameters.
A recipe for cookies calls for the following: 1 cup of shortening, 1 egg, 1 cup of sugar,
2 cups of flour, 1 cup of baking powder, 1/2 teaspoon of baking soda, and 1/2 cup of
nuts. What would you do if you saw this recipe?
a. Cream the sugar with the shortening and proceed.
b. Beat the egg until it is lemon yellow and proceed.
c. Call a friend and ask if she has tried this recipe.
d. Call the cookbook publisher and verify the instructions.
Did you get the right answer? I hope so. All you’d need to know is that a cup of baking
powder is totally inappropriate for a recipe that calls for 2 cups of flour. I hope I’ve
made my point that knowing the normal parameters of a given topic is a critical part of
successful test-taking.
Danger Signs
As an item-writer, I find that I can cook up all sorts of test items using what could
loosely be called “danger signs.” These are items that require you to recognize that
the clinical situation is worrisome and that some immediate action must be taken.
Usually, the action centers on responding to or advising the parents, solving the
problem, or making recommendations or referrals.
As you study, think in terms of the following:
• When does the condition warrant prompt medical attention?
• What would be inappropriate or harmful to recommend?
• What advice to a parent would get you in legal hot water?
Graphics Interpretation
Items that require the interpretation of graphics force you to apply your knowledge
and comprehension skills to the analysis of non-verbal, non-textual cues. Technically,
graphics can be any kind of non-text material, including bar graphs, pie charts, photos,
and drawings. Most of the graphic items on the IBLCE exam will be photos, so we’ll
concentrate on how to prepare for those. However, having said that, I can attest to the
fact that two items on the last IBLCE exam that I took asked me to interpret a graph and
a drawing. So, be prepared for whatever is thrown at you. Let’s take a quick look at Figure
1, then let’s work through the corresponding item.
Which of the following can you determine about this female from the graph in
Figure 1?
a. She is underweight; teach the mother how to increase her milk supply.
b. She is overweight; teach the mother about how breastfeeding may prevent
obesity.
c. Her weight is appropriate for her age; applaud the mother for exclusively
breastfeeding.
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Okay, let’s talk about the photos, because I know that’s what you’ve been waiting for! As
you may know, you will receive a booklet containing all of the photos (or other graphic
images) that are needed to answer the exam items. The items will refer to the photos.
What you may not know is how to look at the photo in a systematic way.
As you interpret each photo, focus on three basic questions. First, is something obviously
wrong or pathologic in the photo? Second, what is the difference in the image from top
to bottom, and from right to left? Third, what is the approximate age of the baby? These
three questions, although not completely sufficient, are necessary for answering all or
nearly all of the photo items. The exam item below and Figure 2 demonstrate how to
interpret the photo.
Which of the following would be appropriate for the baby in Figure 2?
a. supplementary feeds; this baby does not look well nourished.
b. complementary feeds; this baby is ready for those any day now.
c. a teething toy; she is about to cut teeth any day now.
d. exclusive breastfeeding with vitamin D supplementation
To choose the correct response, determine three things right off the bat. First, is
something obviously wrong or pathologic in the photo? No, I doubt it. That makes it
hard to see any indication for option (a). Second, what is the difference in the image
from top to bottom, and from right to left? I can’t see a thing; this photo looks very
symmetrical to me. Third, what is the approximate age of the baby? Hmmmmm. The
baby is grasping the woman’s finger, but it is not a really tight grasp. Because the grasp
reflex disappears at 3 months, I would be willing to guess that this baby is just about 3
months old. Would complementary feeding, as given in option (b) be appropriate for
a 3-month old? No. Would a baby start cutting teeth at 3 months, as listed in option
(c)? It’s possible, but highly unlikely. Therefore, option (d) is the best answer. Exclusive
breastfeeding is best, and the AAP now recommends vitamin D supplementation for
exclusively breastfed infants beginning at 2 months of age.
to remind yourself that the IBLCE exam tests your understanding of normal parameters;
hence, normal photos may be shown. Many of the photos that depict older children are
really demonstrating growth and developmental milestones, so as likely as not, they are
“normal.” Don’t become paralyzed if you can’t see anything wrong in an exam photo.
Mark the item so that you can return to it if you have extra time, but by all means, answer
!
it and move on.
Don’t become
There’s a little tiny speck, and I had assumed there’d be a giant-size plank.
After I convinced myself that some photos actually might be normal, I suddenly started paralyzed
seeing too many “normal” photos. Naively, I assumed that the anomalies in the photos
would be sitting right out there, front and center, saying hello to me. This is usually not if you can’t
the case. I had to train myself to look for tiny skin tags or tiny blisters. What I’ve learned
is that I shouldn’t move on unless I’m sure that there aren’t any teeny tiny things to see anything
observe. I try to carefully examine every centimeter of a photo before declaring what I see
“normal.” Little things matter. wrong in the
I instantly assume that the anomaly is nothing I’ve ever seen before.
After more than 20 years of looking at breasts, there are still things I’ve never seen. It’s
photo.
likely that there are an infinite number of anomalies, and no one of us will see all of them
before we retire. I can tell that to you here, but I find it difficult to accept it myself when
taking an exam. Call it lack of confidence or call it just plain old test anxiety, but I freak
out when I’m taking a test and there’s a photo of something that I’ve never seen before. I
immediately feel stupid and incompetent, and it wrecks my self-confidence for the next 8
items or so. I try to remind myself that if I were sitting next to the woman in the photo,
I wouldn’t freeze or feel stupid. A light would suddenly, magically go on in my head, and
something would remind me of something similar; somehow, I’d figure it out. That’s what
usually happens to me. An interesting side note is that after I do figure out the answer, I
usually realize that I really have seen the anomaly before. I just didn’t recognize it in this
context. I don’t know why I freak out on these questions, but if I am prepared for that
sort of situation in advance, it can’t wreck my confidence quite so much.
I can’t figure out if I’m looking at a breast or a fist.
Honestly, I know this sounds ridiculous, but I recall one photo that had me completely
stumped for about 10 minutes. I couldn’t figure out if I was looking at the top half of
the woman, her fist, or her infant! Her bra also looked funny to me. I finally realized
that her hand was retracting the bra, and the lump I was looking at was an engorged
tail of Spence. Of course, if I had been sitting next to the woman, I would have known
immediately. If you find yourself in this situation, try to find a landmark. When I stared
calmly at the photo, I finally recognized the hair in her underarm area. That helped me to
orient myself and figure out what was what. Learn to look for obvious landmarks if you
need to orient yourself.
I get grouchy because of poor photo quality.
Admittedly, I’m grouchy if the photo I’m looking at in the exam booklet is not of good
quality. However, I have to face the fact that there’s nothing I can do about it. I have to
tell myself, “That’s tough. Now, get over it!” You’d do well to do the same for yourself.
Don’t let a bad attitude about something you can’t control affect your ability to take the
exam. In truth, this might not happen to you at all. Most of the photos used nowadays in
the IBLCE exam are quite good.
My usual ability to distinguish between similar-looking lesions suddenly vanishes.
I think it’s safe to say that you can’t get through the IBLCE examination without seeing
a lesion of some kind. The key is to know your lesions. There may be a million different
variations, but by and large, you can boil them down to a few main types. If you don’t
know the difference between a raised vesicle and a flaky dermatitis, hit the books. Make
sure that you can distinguish the types of lesions from each other before you take the
exam.
My eye is drawn to extraneous material in the image.
Sometimes, there are things that just leap out at me. When presented with a photo
showing a breast and a pump, the first thing my eye is drawn to is the pump. I have
to remind myself to slow down. The pump might not be relevant at all. I need to look
at everything, especially the breast. There, I might see a subtle mastitis. Include many
pictures of mother and babies of varying ages in your studying. Practice identifying which
items are significant and which are distracting. When you’re taking the exam, make sure
you consider everything in the images, but do not allow yourself to be distracted by
extraneous material there.
I make a quick and stupid decision.
Sometimes, I think I know it all. That’s usually when I dive in and make a stupid
decision. When I answer too quickly, I need to stop or, at least, slow down. Don’t be
afraid to take a minute to review each of your responses, as time allows.
I read too far into the situation.
I’m a master of looking at something and adding a slew of “well, maybe it could be...” and
“of course, not all preemie babies have...” and “well, it would depend on...” comments. I
have to remind myself that the photos in the exam are not asking for oddball situations.
The person who submitted the photo or wrote the exam item was thinking about what
generally happens. After all, this is an entry-level examination. Try to think in terms of
the usual situation. As someone once said, “If you’re in Central Park and hear hoof beats,
don’t go looking for zebras!”
Figure 3.
The mother of twins in Figure 3 says that she is worried that she “won’t have enough”
to get the babies through the day today. How might you respond?
a. Explain to her that supplementation is a high likelihood in this case.
b. Explain that milk transfer may be improved by using the cradle position.
c. Reassure her that she has 10-100 ml of colostrum right now.
d. Reassure her that she will have 850 ml by the end of the week.
Option (a) is tempting if you know that the hospital staff is often over-eager to
supplement twins. But it isn’t helpful to interject your bias when answering the question.
Nonetheless, keep that option in mind; it’s a possibility. Option (b) would only be
appropriate if you think the baby is not positioned correctly. You might want to review
this possibility. Option (c) looks like a possibility, but you’re not sure about that 10-100
number. But, you note that the woman is getting IV therapy, which suggests that she has
delivered within the past 0–24 hours and, therefore, has colostrum. That, together with
the observation that she is breastfeeding in the “elevator” position, is a strong clue that
she has had a cesarean delivery. (Offering the lower breast and then elevating the baby on
a pillow to suckle the upper breast allows the mother to avoid rolling onto her other side,
which is uncomfortable after surgery.) Mothers of twins typically have 850 ml of milk per
day once lactation is established, a fact which you may or may not know. But you should
be able to figure out that this woman has given birth a day or two ago, and it is unlikely
that she or any other mother will produce that much milk by the end of this week. Also,
if she has had a cesarean delivery—which you suspect she has—there may be significant
delay in establishing a full supply.
Read all options carefully.
Remember that, like text-only items, photo items require you to read the stem and all
of the options carefully. Keep in mind that the correct answer is literally surrounded by
similar, but incorrect answers. Here’s a case where the old adage “Look before you leap.” is
good advice. Consider each item seriously, and as you go through them, don’t be afraid to
mark “yes,” “no” and “maybe” comments in the margin of your exam booklet.
Harness your clinical acumen.
If you truly have never seen this condition before, harness your clinical acumen. Use all
of the knowledge that you’ve ever amassed to somehow put the pieces together and figure
it out. Even if you’ve never seen this particular anomaly, you can ask yourself: What does
this remind me of? Have I ever heard about this sort of problem? What is affected by it?
Have I ever read anything about this presentation of symptoms?
Types of Distracters
There are multiple distracters that could be written for each test item, but there are
relatively few ways that item-writers can invent good distracters. The expertise of item-
writers varies, and each has a favorite method for creating distracters, but at the end of
the day, there are only a few good strategies they use. If you know the techniques used for
writing distracters, you should be better able to identify and avoid them.
Outdated Information
Outdated information makes for great distracters. An effective distracter is both
!
plausible and similar to the correct answer. That explains why outdated options are good
distracters. This trick instantly allows the item-writer to create one correct option that is
surrounded by similar options. The obvious way to prepare for these items is by staying
current on information about the latest recommendations, equipment, and so forth.
Here’s an example:
Outdated
Which of the following gifts would be MOST likely to thrill your daughter?
a. a 33-LP information
b. an 8-track tape
c. a boom box makes
d. an iPod
Unless your daughter collects antiques, the 33 records that made Elvis popular and the
for great
8-track tapes that were state-of-the-art technology during the Beatles’ heyday aren’t going
to thrill her. If she asked for a boom box a couple of years ago, her wishes have probably
distracters.
changed. The hot thing now is the iPod. By the time that you see this learning package in
print, it’s possible that the iPod will have been replaced by some other newfangled thing.
My point is that outdated information lures you into picking the wrong answer. After
all, it was correct – at one time. Similar to the example above, if you haven’t kept up with
what’s going on in the field of lactation, you’ll be lured by the wrong answer.
“Echo” Options
If two options are opposite, it’s highly likely that one of them of them is the right answer.
Here’s an example:
Which of the following would correctly describe the problem seen in this photo?
a. The shield is too large.
b. The shield is too small.
c. The shield was not applied correctly.
d. The shield is not necessary for this nipple.
To answer this, it would be best if you actually know the information. If you don’t, try
to realize that the item writer probably used one of the size problems (too large or too
small) because one is the right answer, and the opposite one is the wrong answer. Stated
otherwise, something can’t be both too small and too large, so one of the options is
definitely a distracter.
Sounds Like...
Distracters that sound like the correct answer can lure you into picking an option that
isn’t correct. Again, this demonstrates how good distracters tend to be very similar to
the real answer. Here is an example of a test item in which the distracters sound like the
correct option:
Which of the following would be prescribed for a mother who was suffering from
depression?
a. Celebrex
b. Cerebyx
c. Celexa
The obvious way to deal with these is to know your material. You should have studied
pathological conditions that may affect women of childbearing age and medications
that are indicated for those conditions. If you know about depression and medication
prescribed for it, the other two names won’t be able to fool you. Otherwise, it is likely that
you’ll fall prey to one of the distracters that sound like the correct answer.
Looks Like...
Distracters that look like the correct answers are also a killer if you have almost but not
quite mastered the material. Here’s an example of an item in which the distracters look
similar:
Which of the following is normally present in the fetus, but not normal in an infant
3 or 4 days old?
a. foramen magnum
b. foramen ovale
c. mastoid fontanelle
Did you have a little trouble with that? A “foramen” is a passage. “Magnum” means large.
The spinal cord passes through a large orifice in the skull, and meets up with the brain.
Therefore, since everyone needs brains and spinal cords connected throughout life, you
know this structure will remain throughout both intrauterine and extrauterine life. The
fontanelles are open and do not close for several months after birth. The foramen ovale
is an opening that is present for fetal circulation, but it closes after delivery. If you didn’t
know your material, you’d probably have difficulty figuring that out.
to be taken. I think in terms of the likely or most likely situations. I think in terms of what
would be helpful or most helpful to my patients. So, I know this least-likely construction is
my severe weakness, and I know I really need to work on it. You should carefully analyze your
own test-taking to see if qualifiers in the stem pose a particular problem for you, too. In any
case, these items benefit from extra time and review, as available.
!
Qualifiers in the Options
I had
Favor options that use qualifying terms such as “often” and “most.” Such words are incorrectly
generally used in order to provide longer, more detailed explanations that are better
responses than less specific options. When qualifiers appear in options (e.g., an LGA answered
baby born yesterday or a mother who has had history of xyz disease), they are generally
included to make the right answer more right. every single
Be wary of options that use specific determiners or absolute words, such as “always”
or “every.” Try substituting a qualified word for the absolute one (e.g., “frequently” for
item that
“always” or “typical” for “every”) to see if you can eliminate those options. had a “least
Stick With Your First Answer likely”
Research shows that, in general, the first answer you write down is usually the correct one.
So, follow your gut; you are probably right. Do not second-guess yourself. Do not change qualifier!
your answer unless you are absolutely certain that you made a mistake. I can’t count how
many times I have chosen the right answer, then second-guessed myself and erased it to
select an incorrect response instead. This doesn’t just happen to me. Numerous times, I’ve
warned participants of Marie Biancuzzo’s Lactation Exam Review course to stick with
their first answers when taking the mock exam. Then, I administer the exam. When we
have looked at the changes that people made to their first responses, we found that, of
those who wrote an answer and later changed it, more than 50% had written the correct
answer the first time. Trust me on this one. I’ve read it in books, and I have plenty of
empirical information to back up my recommendation: Don’t change your answer unless
!
you are sure you made a mistake.
!
exam is given every July.”
Summary
Your success in passing the IBLCE starts with mastering the mundane. Feeling informed
and confident of the site details and minimizing any last-minute snags will help
you to approach the exam feeling reasonably unhurried and relaxed. Preparing for a
comprehensive examination is always a daunting task; studying for the IBLCE exam is no
exception. However, by knowing what to expect on the exam and using effective study
strategies, you’ll be able to prepare yourself better. Recognizing your own weaknesses,
especially with photo and “least likely” items, will enable you to better prepare for and
eventually take the exam. Understanding how exam items are constructed will help you
to more easily dismiss the distracters and choose the right answers. Whether you feel
very sure, a little uncertain or completely stumped, you can maximize your chances for
successfully answering any item by using the strategies discussed in this learning package.
Good luck!
References
1. Meyers JN. The Secrets of Taking Any Test: Learn the Techniques Successful Test-Takers
Know. 2nd ed. New York, NY: LearningExpress; 2000.
2. Biancuzzo M. Breastfeeding the Newborn: Clinical Strategies for Nurses. St. Louis, MO:
Mosby; 2003.
3. Smith L. Comprehensive Lactation Consultant Exam Review. Sudbury, MA: Jones &
Bartlett; 2001.
6. During the first 20 minutes of suckling, you could say that serum prolactin levels
a. somewhat decrease from baseline.
b. more than double from baseline.
c. more than triple from baseline.
9. Lysozyme is an
a. ion.
b. enzyme.
c. interferon.
d. immunoglobulin. continued on the next page
13. Which two deficiencies would be most likely to occur in a lactating woman?
a. calcium and zinc
b. calcium and phosphorus
c. magnesium and zinc
d. potassium and zinc
14. A mother with CMV gave birth to a baby who weighed 1427 grams at birth. She
wants to know if it is okay to breastfeed. Which of the following would be your
BEST response?
a. Reassure her that breastfeeding is not contraindicated for CMV.
b. Talk with her and her doctor about some possible precautions.
c. Initiate breastfeeding only after the infant has had the HBIG vaccine.
d. Gently inform her that breastfeeding is strictly contraindicated in this case.
17. When choosing a breast shell for a woman with flat nipples, you would choose the
style with which of the following characteristics?
a. a smaller hole.
b. a larger hole.
c. a cotton insert.
continued on the next page
19. You are watching 4-week old Timmy while he suckles his mother’s breasts. Which of
these observations would require further follow-up?
a. His tongue is extended over his lower alveolar ridge.
b. Long, slow rhythmic sucks are preceded by several short 1-second sucks.
c. He takes about 5-8 sucks and then he swallows.
d. He continues to suck until he is completely asleep.
20. A mother reports that she has an itching, burning feeling in her breasts especially
after she finishes breastfeeding Tony. The MOST important advice you could give
her is that she should
a. give her breasts a rest over the weekend, and continue breastfeeding after she has
had a chance to heal.
b. avoid the new soap that she says she purchased; this is a likely cause of her
discomfort.
c. make an appointment to see her health care provider as soon as possible.
d. try some over-the-counter Neosporin ointment and call her health care provider
if it doesn’t clear up within a day or two.
21. A mother of a 4-month old calls and says that she and her baby are enjoying great
health, and she is delighted that everything has gone so well for them. She notices,
however, that some milk that she stored in her refrigerator yesterday has a soapy,
cloudy appearance. She wants to know what to do. You should tell her that
a. the milk is fine; she can warm it and swirl it gently before giving it to the baby.
b. the milk is spoiled; she should discard it and call her doctor and hope that she
can get started on antibiotics right away.
c. the milk is questionable; it needs to be sent for a laboratory analysis before any
recommendation is made.
22. A woman reports that she has caught a cold, and she feels miserable. She says that she
is already using the products listed below. Which of these is MOST likely to reduce
her milk supply?
a. Tylenol.
b. Sudafed.
c. Mentholyptus cough drops.
d. Afrin nasal spray.
23. Your client and her infant have had a difficult time getting breastfeeding to go
smoothly. The mother finally confesses that when he arches his back and pulls away
from her, she wants to hit him. Which of the following would you do?
a. Document this feeling and past experience with the client that she is gentle and
would never harm the baby.
b. Document her exact quote, and notify the state authorities.
c. Document her exact quote, and notify her physician.
d. Remember this, and document it if she says it again.
continued on the next page
25. A colleague of yours says that the Pump In Style® pump is being used by several
clients in her clinic. She wants to know if this is okay. You remind her that
a. the FDA says that this is okay, as long as the mother use their own accessory kits.
b. the manufacturer advertises this as a single-user product.
c. the Durable Medical Equipment Act prohibits sharing of any pumps, regardless
of design or brand.
d. there are no official standards on whether this is okay or not.
Post-Test
Instructions: Answer all ten of the following questions. You may write on this sheet as
much as you like, but to earn your continuing education credits, you must submit your
answers on the answer sheet provided on page 38.
1. Using a mnemonic is helpful for:
a. remembering a fundamental principle.
b. remembering a list of things.
c. estimating a mathematical calculation.
d. eliminating a non-plausible answer.
2. An instructor is presenting a lactation exam review course. She realizes that no one
noticed that the right breast showed veining and the left breast did not. Which of the
following should she recommend for course participants?
a. A better familiarity with the changes of pregnancy.
b. A better understanding of the effects of veining.
c. Looking at the photo for superior-inferior symmetry.
d. Looking at the photo for left-to-right symmetry.
3. You are having difficulty remembering which of the cranial nerves is primarily
responsible for swallowing. Which of the following strategies might be MOST
helpful for mastering the information?
a. Trading war stories with a colleague about a baby who could not swallow.
b. Having a clear command of prefixes and suffixes.
c. Using some form of distributed practice.
d. Using kinesthetic clues for better recall.
4. An instructor notices that on her mock exam, participants frequently choose
“massage the area proximal to the plugged duct” rather than the correct option,
“massage the area distal to the plugged duct.” The MOST likely reason that
participants miss this question is that they do not understand:
a. effective management of plugged ducts.
b. how to achieve proper breast massage.
c. the meaning of the words in the options.
d. the basic principles of lactation management.
5. Which of the following would be LEAST LIKELY to help you on the IBLCE exam?
a. jotting a diagram next to the item in the test booklet.
b. leaving an item unanswered to avoid a penalty for a wrong answer.
c. crossing out options in the test booklet that are incorrect or questionable.
d. randomly picking an answer and darkening the circle on the answer sheet.
6. After writing the entire exam, you review all of your answers. You feel that you might
have made a mistake answering #42. You have answered #40, #41, #42, and #43 with
option A. You should change your answer ONLY if you
a. have second thoughts about your initial response.
b. think there are too many “A” responses.
c. are absolutely certain your first answer was wrong.
Post-Test (continued)
7. You read the stem and the four options of a test item. You are really struggling to
select the correct answer. Which of the following strategies will NOT be helpful?
a. Selecting option A because has a qualifier in the stem.
b. Selecting option B because it reminds you of a similar situation you’ve seen in
clinical practice.
c. Selecting option C because it seems within what you guess might be normal
parameters.
d. Selecting option D because it’s the only option with a word you don’t recognize.
8. While taking the IBLCE exam, you find yourself staring at a photo of a child who is
breastfeeding while standing. The mother looks comfortable. The child’s latch looks
good. You can’t figure out what’s wrong in the photo. You finally conclude that:
a. the photo quality makes it impossible for your to figure out what’s wrong, so you
should simply guess.
b. you should write a comment on your critique form that it’s impossible to
determine what’s wrong in this photo.
c. the correct answer must have something to do with the standing position.
d. you should trust your gut, assume that nothing is wrong, and pick the option
that reflects that.
9. Excellent distracters include all of the following EXCEPT those that are:
a. written with outdated information.
b. chosen by the vast majority of exam writers.
c. very similar to but different from the correct response.
d. implausible in any situation.
10. You decide to memorize the 206 bones of the body. The MOST effective strategy
would be to:
a. order them alphabetically, and use flash cards to memorize each.
b. write them all down again and again until you memorize them.
c. say them out loud again and again until you memorize them.
d. memorize one body part or cavity (the hand, the chest, etc.) at a time.
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COMPLETE BOTH THIS AND THE FOLLOWING PAGE and mail or fax to:
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13. How did you find out about this learning package?
. Course or conference display.
. Ad on the worldwide web.
. Ad in Journal of Human Lactation.
. Flyer in the mail.
. Heard from friend or colleague.
. Other _ ______________________________________________________________________________