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Certified Lactation Course Exam: Questions and Answers, Exams of Nursing

A comprehensive set of questions and answers for a certified lactation course exam. it covers various aspects of breastfeeding, including the history of breastfeeding practices, breastfeeding barriers, breast anatomy and physiology, milk production, and colostrum versus mature milk composition. The detailed information makes it a valuable resource for students studying lactation.

Typology: Exams

2024/2025

Available from 05/12/2025

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CERTIFIED LACTATION COURSE EXAM||2025-2026||-
QUESTIONS WITH CORRECT VERIFIED ANSWERS.
A+ GRADE
weaning
the addition of adding other foods to a diet, but not completely stopping or ceasing
breastfeeding
when did breastfeeding rates start to initially decline (i.e. in Britain), particularly
among the wealthy population?
16th-17th century and through the 18th century
which month did women historically think was the most important to breastfeed
during?
the summer (due to food spoilage)
what three ingredients made up the first commercial formula? (early 1800's/19th
XXWQcentury)
-wheat flour
-cows milk
-sugar
what was, and still is today, one of the biggest reasons why mothers quit
breastfeeding?
mothers report not producing enough milk
when did bottle feeding become the "new norm", thus, causing breastfeeding rates to
continue to decline?
20th century (particularly, mid 1900's) (1950's-1970's)
what is the WHO code?
an attempt to prevent excessive marketing of ABM (artificial baby milk) and to bring
awareness of benefits of breastfeeding (although this code is not law in many
countries as it interferes with marketing & freedom)
breastfeeding education to pubic is critical!
what are some other breastfeeding barriers mothers have?
-sexual vs functional aspects of breasts
-women in the workplace
-"im not producing enough milk"
-lack of support from medical profession
pf3
pf4
pf5
pf8
pf9
pfa

Partial preview of the text

Download Certified Lactation Course Exam: Questions and Answers and more Exams Nursing in PDF only on Docsity!

CERTIFIED LACTATION COURSE EXAM||2025-2026||-

QUESTIONS WITH CORRECT VERIFIED ANSWERS.

A+ GRADE

weaning

the addition of adding other foods to a diet, but not completely stopping or ceasing

breastfeeding

when did breastfeeding rates start to initially decline (i.e. in Britain), particularly

among the wealthy population?

16th-17th century and through the 18th century

which month did women historically think was the most important to breastfeed

during?

the summer (due to food spoilage)

what three ingredients made up the first commercial formula? (early 1800's/19th

XXWQcentury)

  • wheat flour
  • cows milk
  • sugar

what was, and still is today, one of the biggest reasons why mothers quit

breastfeeding?

mothers report not producing enough milk

when did bottle feeding become the "new norm", thus, causing breastfeeding rates to

continue to decline?

20th century (particularly, mid 1900's) (1950's-1970's)

what is the WHO code?

an attempt to prevent excessive marketing of ABM (artificial baby milk) and to bring

awareness of benefits of breastfeeding (although this code is not law in many

countries as it interferes with marketing & freedom)

breastfeeding education to pubic is critical!

what are some other breastfeeding barriers mothers have?

  • sexual vs functional aspects of breasts
  • women in the workplace
  • "im not producing enough milk"
  • lack of support from medical profession

where are the breasts specifically located on the body?

  • between 2nd & 6th rib
  • from sternum to mid axillary line
  • only gland in not fully functioning at birth

*may contain hair, sweat, and oil glands

hypoplastic breasts

  • insufficient glandular tissues
  • usually only extend from 3rd to 5th rib
  • typically have more spacing between breasts (1.5 inches or more)

montgomery glands/tubercles

"small bumps" located around areola that become more prominent (hypertrophy)

during pregnancy & are thought to secrete substance during pregnancy/lactation &

contain scent glands to help guide infant to nipple, while also helping kill pathogens

that try to enter the body

areola

vary in shape & color; usually circular; become darker during pregnancy and do not

return to pre-pregnancy color

nipple

contain smooth muscle fibers for erectness and graspability; normally found at 4th

intercostal space that typically contain between 4-18 openings (9 on average) for

milk to be expressed through during lactation

nipple/areola complex

thought of as one entity; both elongate up to 2-3 times resting length during

breastfeeding;

areola = most sensitive part of breast

nipples = least sensitive

everted nipples

most common type of nipples; protrudes slightly at rest & everts well with stimulation

flat nipples

soft, but pliable & graspable

pseudo-inverted nipples

what is witch's milk?

breast buds/neonatal engorgement in full term infants that may be mistaken for baby

acne; self resolve by 4 weeks pp

why is it critical to ask mothers about breast changes during pregnancy when

completing an assessment

different hormones cause breast changes during pregnancy which are critical in

assisting with breastfeeding in the pp period;

examples:

  • estrogen: cause ductile system to proliferate
  • progesterone: promotes and increases the size of breast lobes and alveoli
  • serum prolactin: nipple growth
  • serum placental lactogen: areolar growth

Lactogenesis I

occurs between 16 - 20 weeks of pregnancy until milk surges, or comes in, after birth

breast size increases

differentiation between alveolar cells into secretory cells occur

hormone prolactin stimulates mammary secretory epithelial cells to produce milk

endocrine (hormonal) control

Lactogenesis II

occurs between PP day 3 - 8 where there is a rapid increase in milk volume for 2- 5

days, then abruptly levels off; this is the onset of copious milk supply

triggered by rapid drop in progesterone levels after placenta is delivered

will feel fullness and warmth in breasts

now switches from endocrine to autocrine control

galactopoiesis

maintenance of the established milk production under autocrine control

works on a supply & demand basis

breasts will decrease slightly by 6-9 months pp

involution

the process of weaning slowly over 3 months or longer when FIL (feedback inhibitors

of lactation) in breastmilk suppress lactation if milk is not removed from the breasts

describe colostrum

  • "first milk"
  • starts about 16-20 weeks gestation and mom may or may not leak this during

pregnancy (which is normal, nothing to worry about);

  • clear to golden yellow in color, but may be greenish or brownish due to old blood
  • very dense and thick, gel-like; present in small aounts
  • acts as "gut primer" or "closure"; helps block out pathogens and clear meconium out

of gut

  • physiologic capacity of stomach: only 20 mls at birth (note: anatomic capacity is

much larger, do not go by this)

transitional milk

milk produced between colostrum and mature milk; occurs by 3 days PP

occurs when "milk comes in" or when "milk comes to volume"; sensation of fullness

occurs during lactogenesis II

caused by rise in lactose in cells which draw water into secretion by osmosis and

enhances milk volume; can be sped up by increasing frequency of breast emptying

in first few days pp

mature milk

occurs between days 10 - 14 and onward

the longer the breastfeed, the higher the fat (caloric) content of milk (in both one feed

and longevity of feedings); fat content higher at end of feedings and the longer one

breastfeeds for in total

not all breastmilk is 20 cal/ounce

milk in second year of lactation has significantly increased fat & calories

Describe the differences between colostrum & mature milk in terms of composition

Colostrum: higher protein, higher cholesterol, high IgA antibodies

Mature milk: higher energy (calories), higher lactose, higher fat (the emptier the

breast, the higher the fat content in the milk because there is more fat toward the

end of breastfeeding)

what is the average caloric value of breastmilk (per ounce)?

First 3 weeks of life: 20.2 - 28.2 kcal

6 months: 22.5 - 36.25 kcal

9 months: 22.9 - 32.4 kcal

12 months: 19.4 - 34.6 kcal

*Essentially, it ranges from 18 - 23 kcal/oz

What volume of milk approximately should mom be pumping and should be used to

supplement if needed during first 5 days of life?

Day 1: 5 ml/feed

Day 2: 15 ml/feed

Day 3: 30 ml/feed

Day 4: 45 ml/feed

Day 5: 60 ml/feed

fat variation also is more specific to each baby's needs, thus, decreasing amount

baby needs to take from breast

remember: breast milk is , while formula is

alive; dead

what things should be assessed in the breastfeeding infant, which may affect how

well infant feeds or show effectiveness of breasfeeding?

  • gestational age (term infants feed best)
  • birth hx (long 2nd stage, forcep/vacuum use, position in utero, meconium aspiration,

AGAR scores, resuscitation efforts

  • baby's ability to breastfeed (is anything out of the NORM)
  • oral assessment/exam (tongue tie? thrush? cleft lip/palate? moist or dry mucous

membranes?)

  • alertness levels (feeding cues, stress signals)
  • muscle tone (normal extremity flexion? resistance when undressing or wet noodle?

head lag when in sitting position?)

- I&O:

1 void/day of life until day 5-6, then several a day = normal (excessive voiding in first

12 - 24 hours of life can be due to excessive maternal fluids during labor; if baby loses

more than 10% of weight but is feeding well with many many pees & poops--DONT

WORRY)

3 "scoopable" stools or more a day by day 4= normal

  • Weights:

All infants will lose weight; Infant should be back to birth weight by day 10 pp & one

ounce weight gain per day until 3 mos old; normal weight loss = no more than 6.6%

**What is considered the norm when assessing an infant?

healthy, vigorous, full term infants

what infant stage of behavior do infants feed best in?

quiet alert stage

what are some hunger cues and infant might display, which tells the mother she

should put infant to breast immediately?

  • mouthing (rooting)
  • hand to mouth
  • hand swipes to mouth
  • sucking on hand
  • tonguing
  • head bobbing

what is the best intervention of under or over-aroused infants to help get them to

feed?

skin to skin

what is the Dancer Hand Position?

position mothers can use during breastfeeding to help support the breast and the

infant's jaw simultaneously during a feed

*very useful for hypotonic babies (i.e. LPT, Downs, preterm, mandibular asymmetry)`

what is the best way to know that breastfeeding is going well?

PAIN FREE WEIGHT GAIN

What is the best way to identify sick infants, which need further assessment and

intervention

Infants that dont want to eat:

  • baby refuses to nurse 2x in a row
  • 3 poor feedings in a row, after good feedings have been established

*Baby's physician needs to be contacted

what is another name for mongolian spots?

gray slate nevus

can a mother breastfeed an infant with galactosemia?

NO

Common traits in Down Syndrome:

  • low muscle tone*
  • flat facial features
  • upward slant to eyes
  • low set ears
  • enlarged tongue
  • super flexible
  • single crease in palm of hand
  • excessive spacing between toes
  • congenital heart conditions

Is it okay to breastfeeding during a pregnancy?

Yes, unless mother has hx of preterm labor

What are the best practices to exhibit when counseling breastfeeding women?

  • provide small, tidbits of information at various times so as not to overwhelm mother
  • counsel women AT LEAST 4x for best outcomes
  • face to face counsel sessions
  • get on same eye level as mother (ex. sit knee-to-knee)
  • eye contact
  • be conscious of: tone of voice, body language, and facial expressions
  • interact with mothers to allows them to participate in learning/counseling (ask

questions, etc.)

  • address/focus on mother's needs & concerns

TOP THREE:

  1. Ask OPEN-ENDED questions
  2. Affirm feelings
  3. Educate

What is the most important goal in helping breastfeeding mothers achieve for

success?

CONFIDENCE

which hormone helps keep milk production under control until after delivery?

Progesterone--levels drop after delivery of placenta & milk production begins in

earnest

prolactin

hormone that builds up during pregnancy to get ready to make milk by acting on

lactoycytes; manufactures in hypothalamus and stored in anterior pituitary gland

what is the role of prolactin?

prolactin receptors develop early in lactation and remain constant after that, so

increasing prolactin levels are not needed it is permissive rather than regulatory

when is it important to establish good feeding techniques?

In the first two weeks; early and often

  • Remember: 8 or more in 24 (number of feedings/day, except for possibly first 24

hours)

  • some cluster feeding, some longer intervals in between
  • good, quality sucking: more about quality than quantity (not all about the length of

feedings)

  • rhythmical sucking with swallowing (audible) & breathing: suck/swallow/breathe

pattern

  • several sucking bursts accompanied by occasional pausing
  • baby's mouth wide open
  • deep, ASYMMETRICAL latch (jaw pressed to breast, nose up and out)
  • mother reports: fatigue, thirst, cramping
  • nose & toes of infant pointing same direction
  • ears, shoulders, hips of infant lined up

Once milk comes in:

  • infant should appear sleepy after feeds
  • 1.5- 2 hour intervals between feeds

Describe normal infant stools:

Mec: First 2 - 3 days

Transitional (greenish): Days 3- 4

Yellow/seedy: By Day 5

Remember, 3 scoopable (good sized) poops/day by day 4

what is cholecystekinin (CCK)

a GI hormone that enhances digestion & causes sedation and feeling of well being;

is released to both mother and baby within 10- 30 mins of end of feed

what is important to remember when promoting breastfeeding?

breastfeeding is normal, not sexual

  • every feed counts (do not focus on rules/exclusivity)
  • engagement/education (early) in pregnancy is important
  • help mothers feel confident with breastfeeding
  • tell the truth about BF: it can be challenging
  • encouraging partner support & education for support person
  • health care providers need to support BF
  • breastfeeding classes, prenatal classes, etc.

List the 11 steps to SUCCESSFUL breastfeeding?

1A. Comply full with International Code of Marketing & WHA resolutions

1 B. Have a written evidence-based breastfeeding policy that is routinely

communicated to ALL health care staff (keep short & simple so they are

implementable)

1C. Establish ongoing monitoring and data-management systems in your facility

(TJC req.)

  1. Educate staff- Ensure they have sufficient knowledge, competence, and skills to

support breastfeeding (this includes ALL interdisciplinary team members in a facility)

& evaluate staff attitudes towards BF

  1. Prenatal education- discuss importance & management of BF with pregnant

women and and their families at prenatal visits and classes/tours

  1. Skin to skin- immediately & uninterrupted for at least 60 minutes
  2. Maintain lactation & essential education- positioning & latching, prevention of sore

nipples & engorgement, how to tell infant is "getting something", nutritional concerns

  1. Breastfeed Exlusively- nothing other than breast milk unless medically indicated
  2. Rooming in- remain together 24 hours a day, decrease interruptions on PP unit

(cluster cares)

  1. Breastfeed on cue- recognize hunger cues & respond, do not feed "according to a

clock"

  1. No bottles/pacis- prevent nipple and/or flow confusion
  2. Support groups & follow ups- discharge planning for follow-up, breastfeeding

support groups & resources within 3 weeks or less

  1. Interventions- decrease the use of interventions during the labor process; honor

& support mother's wishes & birth plan & offer nonpharm pain relief methods when

possible

What baby-friendly practices & initiatives can help initiate & protect against early

termination of breastfeeding?

  • Breastfeed within first hour
  • Give only breast milk (exclusive breastfeeding)
  • Rooming in
  • Breastfeed on demand
  • No pacifier use
  • Provide info on BF support on discharge

What are some birthing practices that HCPs and CLS's can delay to promote

bonding and breastfeeding between mothers & infants?

  • infant physical exam in L&D
  • infant weight
  • suctioning
  • eyes (after first feed) & thighs (within 4 hrs)
  • painful procedures
  • swaddling
  • maternal-infant separation

Are L&D interventions for mothers, such as IVs, EFM, pitocin, and eating/drinking

restrictions evidence-based?

No! Often they are encouraged by HCPs because L&D is associated with risk and

danger.

What is the trouble with epidurals in labor?

  • often cause a cascade of events which can impact ease of breastfeeding
  • change mother's muscular status, which makes delivery harder and increases

length of second stage of labor

  • lead to lower oxytocin levels during and following labor
  • pain meds (ie fentanyl) significantly decrease likelihood of baby suckling while skin

to skin during first hour

  • epidural medications CAN get into baby via blood, etc.

what are some negative effects of using synthetic oxytocin (pitocin) during labor?

  • antidiuretic effect: edema in moms breasts causing latch issues due to firm nipples

(babies also retain water weight from IV therapy during labor causing inaccurate birth

weight, and often excessive diuresis in first 12-24 hours)

  • lower apgar scores
  • unexpected NICU admissions
  • neonatal jaundice
  • the longer epidural medications & pitocicin runs with inductions, pp, etc., the

lower the moms own endogenous oxytocin levels during breastfeeding,

causing difficulties with establishing BF