Deck 1: Breast-Feeding

Question 1

Newborns typically nurse how often?

A)Every four hours, and not a moment sooner
B)Five times
C)Every hour
D)8-12 times per day

Answer 1

8-12 times per day

Question 2

The two main hormones responsible for lactation are?

A)Epinephrine and norepinepherine
B)Endorphins and estrogen
C)Oxytocin and prolactin
D)Prolactin and estrogen

Answer 2

Oxytocin and prolactin

Question 3

A mother has breast tattoos and nipple piercings. She asks you if she will be able to breastfeed. The best response is:

A)"Why did you ever get those, anyway?"
B)"You must not breastfeed if you've ever had any body art or adornment."
C)"If your tattoo or piercing is healed, there is no reason for it to interfere with breastfeeding."
D)"You should not breastfeed because you may have been exposed to HIV or hepatitis when you had the procedure done."

Answer 3

"If your tattoo or piercing is healed, there is no reason for it to interfere with breastfeeding."

Question 4

Colostrum, the first milk after birth, is the perfect nutrition for a newborn baby. Which of the following is NOT a property of colostrum?

A)It is low in fat.
B)It is high in carbohydrates and protein.
C)It is high in fat.
D)It is full of antibodies.

Question 5

Lactogenesis II, when a mother's milk "comes in," usually happens:

A)In the first 24 hours
B)A week after birth
C)2-5 days after birth
D)When the placenta is delivered

Question 6

It is best to nurse a baby at the earliest signs of hunger. Which of the following is NOT a sign of hunger:

A)Moving the hands to the mouth
B)Rooting
C)Sticking the tongue out
D)Sleeping

Question 7

A mother you are helping in the early postpartum days asks what is the best way to be sure her baby is getting enough to eat when breastfeeding. Which of the following will you NOT tell her:

A)"Your baby should have 6-8 wet diapers a day."
B)"Your baby should nurse only 10 minutes per side."
C)"Your baby should have at least three bowel movements per day."
D)"Your baby should gain 4-7 ounces per week."

Question 8

A mother tells you she plans to nurse her baby, but only for the first week because after that there's really no benefit. Your best response is:

A)"You're crazy - how can you even think about quitting so soon after birth?"
B)"I'm glad to hear you want to give your baby the best start. Do you have any questions about breastfeeding?"
C)"You're right, it's all about the colostrum in those first few days."
D)"Who told you that?"

Question 9

Research has shown that keeping a baby skin-to-skin with his or her mother immediately following birth has many benefits. Babies will typically self-attach and breastfeed within the first hour if left skin-to-skin. All of the following common practices interfere with this process, except:

A)There are bright lights on in the room.
B)The baby is taken to a "warming table" to be examined.
C)Excited relatives are getting their first chance to hold the baby.
D)The mother had pain medications for birth.

Question 10

A mother calls you several days after her baby is born, and asks what she can do about her swollen, sore, hard breasts. You tell her:

A)"It sounds like your milk may be "coming in." Tell me a little about your baby's feeding patterns so far, and we'll figure out the best course of action."
B)"You must have an infection. Stop breastfeeding right away."
C)"Breastfeeding shouldn't hurt. You must be doing something wrong."
D)"Are you scheduling your baby's feedings?"

Question 11

A mother has inverted nipples, and asks you if she will be able to breastfeed. All of the following are true EXCEPT:

A)Devices such as nipple shields, breast shells, and pumps may facilitate breastfeeding when a mother has inverted nipples.
B)She should give up her hope of nursing, because moms with inverted nipples can't breastfeed.
C)Many mothers with inverted nipples are able to successfully nurse their babies.
D)If the inversion is unilateral the other breast will make enough milk for the baby.

Question 12

Which of the following is NOT a risk of artificial feeding?

A)Increased risk of obesity for the baby
B)Increased risk of otitis media for the baby
C)Increased risk of breast cancer for the mother
D)Decreased risk of gastrointestinal illness

Question 13

Which of the following is FALSE about human breast anatomy?

A)Glandular tissue makes up as little as half the breast volume.
B)On average, approximately nine milk ducts terminate at the nipple.
C)Lactiferous sinuses can be found approximately one inch from the base of the nipple.
D)Milk ducts can be easily found and compressed.

Question 14

If a newborn breastfed baby is jaundiced, what is the optimal treatment plan?

A)The baby should be weaned for two days, and only then resume breastfeeding.
B)The baby should continue to breastfeed on cue, and should be supplemented at the breast with expressed breastmilk, donor milk, or formula, using a cup or syringe.
C)The mother should breastfeed twice a day, and formula feed for the remainder of the day's feedings.
D)The mother should pump as often as her baby was breastfeeding, and should bottle-feed her baby the expressed milk.

Question 15

You are working with an expectant couple, and the partner is hesitant about breastfeeding. You want to help him best support the mother and baby after birth, and you know that fathers can undermine breastfeeding by:

A)Letting mom know he supports her decisions.
B)Suggesting getting away for a weekend without their young baby.
C)Learning the basics of breastfeeding before the baby arrives.
D)Helping around the house with basic tasks so mom can focus on feeding the baby.

Question 16

A mother you are helping is positioning her baby at the breast, and you notice her hand is cupping the back of the baby's head. To help her achieve the best latch, you recommend she:

A)Never use that position again.
B)Doesn't know what she's doing.
C)Lean forward to "drop" the breast into baby's mouth.
D)Not push the back of baby's head, as the baby may resist by pushing backwards away from the breast.

Question 17

A mother who has just given birth is taking pain medications. She asks you if it's OK to breastfeed. The LEAST EFFECTIVE response is:

A)"Only if you want your baby to sleep all the time."
B)"We can ask the nurses which medication your care provider has prescribed, and see what information we can find about how it affects breastfeeding."
C)"Just watch for sleepiness in your baby - you may need to wake him more often to nurse."
D)"Only small amounts of most common postpartum pain relievers get into mother's milk."

Question 18

The LEAST EFFECTIVE way for a mother to bring in a good milk supply is:

A)Nursing her baby often
B)Feeding her baby "on demand"
C)Only nursing 10 minutes on each side
D)Putting her baby to the breast within the first hour after birth

Question 19

The protein in human milk is important because:

A)It has antibacterial properties.
B)It is more easily digestible than cow's milk protein, the basis for many infant formulas.
C)It helps with the processing of iron and lactose.
D)All of the above.

Question 20

Human milk is rich in fat. The fat content of human milk changes during each breastfeeding session, from day to day, and over time. However, the ____________ the interval between feedings, the _________the fat content of the milk.

A)Shorter / lower
B)Longer / lower
C)Greater / less change in
D)Longer / higher

Question 21

While almost all women can breastfeed, certain conditions preclude breastfeeding. Which of the following is reason to NOT breastfeed?

A)Maternal HIV positive status
B)Mastitis requiring antibiotics
C)Maternal Hepatitis C infection
D)Mother using hormonal methods of birth control

Question 22

What is the main sugar in breastmilk, providing half of a baby's energy needs?

A)Lactose
B)Fructose
C)Glucose
D)Sucrose

Question 23

A mother whose baby is two days old tells you she has sore nipples. Your best suggestion is:

A)"Let's work on adjusting your positioning and latch to see if that helps."
B)"Sometimes breastfeeding just plain hurts."
C)"You should ask the nurses for a nipple shield."
D)"Your baby is using you as a pacifier."

Question 24

The mother of a newborn calls you from the hospital several hours after the birth and tells you she just can't get the baby to latch. Which of the following suggestions will NOT help in this situation?

A)Spending time skin-to-skin
B)Giving a bottle of formula
C)Being patient and waiting for the baby to be ready
D)Trying different positions

Question 25

A pregnant mother tells you she wasn't able to nurse her first baby. She says her milk never came in. Which of the following birth circumstances might be related to a delay in milk production?

A)Long second stage
B)Caesarean birth
C)Episiotomy
D)Induction

Question 26

A baby born with the help of forceps is having trouble breastfeeding. You suggest to the mother that:

A)She contact her attorney to sue the healthcare provider.
B)She will need to use a bottle until the baby feels better.
C)She try different positions to find one most comfortable for baby.
D)Her baby will likely have permanent nerve damage.

Question 27

In order for a baby to transfer milk, the baby's latch needs to be effective. Which of the following is FALSE about latching?

A)The baby's mouth is open less than 90 degrees.
B)The baby's nose is slightly touching the breast.
C)The baby's chin is pressed into the breast tissue.
D)The baby takes the nipple and much of the areola into his mouth.

Question 28

A baby is born ill, and is taken to the Neonatal Intensive Care Unit (NICU) immediately after birth. The BEST way to help the mother initiate breastfeeding is:

A)Tell her she needs time to rest.
B)Help her get a hospital-grade pump and begin pumping as soon as possible, saving the colostrum and milk until the baby is ready for it.
C)Tell her she'll have to switch to formula anyway, so there's no use trying to breastfeed.
D)Tell her the baby will have nipple confusion if he gets any bottles in the NICU.

Question 29

The benefits of breastfeeding in the first hour after birth include all of the following EXCEPT:

A)Decreased risk of postpartum hemorrhage
B)Increased incidence of nipple soreness
C)Improved lactation
D)Longer duration of breastfeeding

Question 30

Your client is 24 hours postpartum. The nurses have suggested keeping the baby in the nursery overnight so the mom can get some rest. She asks your advice. Which of the following is NOT part of your counseling about "rooming-in"?

A)"You will get more rest if your baby stays in your room."
B)"The nurses will probably give the baby a pacifier if you let them keep him at night."
C)"Rooming-in allows you to learn your baby's rhythms, and to catch early feeding cues which makes breastfeeding easier."
D)"Babies who are kept in their mothers' rooms cry less."

Question 31

The _________________, or milk-making glands, are secretory cells that connect to ductules.

A)Alveoli
B)Montgomery's tubercles
C)Cooper's ligaments
D)Areolae

Question 32

A mother tells you she doesn't think she can breastfeed because she doesn't eat the right diet and she likes to have an occasional beer (something she hasn't done while she's pregnant). What is your BEST response?

A)"Your milk will be watery."
B)"You should definitely steer clear of alcohol and caffeine."
C)"You shouldn't put your needs ahead of your baby's."
D)"Your body will still make the perfect milk for your baby."

Question 33

A breastfeeding mother is about to be discharged from the hospital two days after birth, and her care provider asks her what form of birth control she plans to use. She asks you for suggestions. You tell her:

A)"Some moms experience a decrease in their milk supply when they start taking 'the Pill.'"
B)"Breastfeeding cannot be used as a form of birth control."
C)"You don't need to worry about that."
D)"You can only use condoms or a diaphragm when you are breastfeeding."

Question 34

Your client is pregnant, and has written a birth plan that includes spending time skin-to-skin with her newborn until the first feeding has taken place. Which of the following is FALSE about skin-to-skin care?

A)The newborn's body temperature will stabilize more quickly.
B)The baby will be at risk for falling to the floor.
C)The newborn's heart rate and respiration will normalize more quickly.
D)The baby will cry less.

Question 35

A mother you are supporting asks if there is anything she can do to prepare her nipples for breastfeeding. You tell her:

A)"Stock up on lanolin because most women have nipple soreness for the first six weeks."
B)"There is really not anything in particular you can do to 'get your nipples ready,' but knowing if you have flat or inverted nipples can help you avoid pitfalls in the early days."
C)"You should rub your nipples with a washcloth 10 minutes each day to toughen them up."
D)"You need to use a strong soap to keep them clean for your baby."

Question 36

A doula is assisting a client and her infant a week after delivery. The infant's birth weight was 7.5 pounds. Which of the following indicates that the infant is getting enough milk?
I. The mother reports that the infant is wetting six to eight diapers a day.
II. The mother informs the doula that the infant appears content between feedings.
III. The infant's weight is 6.8 pounds.
IV. The mother reports that the infant quietly swallows during breastfeeding.

A)I and II
B)I, II and III
C)I, II and IV
D)All of the findings indicate sufficient milk intake.

Question 37

A mother who gave birth a week ago contacts her doula complaining of a cracked and fissured nipple on her right breast. The mother has been diagnosed with mastitis by her healthcare provider. Which of the following teachings is the most effective when helping a client with mastitis?

A)Instruct the client to discontinue breastfeeding until antibiotic therapy is completed.
B)Instruct the client to start breastfeeding on the left breast.
C)Instruct the client to offer formula milk if the breasts are too painful when breastfeeding.
D)Instruct the client to avoid wearing bras until the pain is tolerable.

Question 38

An 18-year-old client is pregnant for the first time. A few weeks before her due date, the client informs the doula that she has decided to breastfeed her baby after birth. As a part of the teaching plan, the doula informs the client that it is recommended she add some calories to her current diet to ensure sufficient milk production without compromising her own health. If the pre-pregnancy recommendation is 2,200 calories per day and the pregnancy recommendation is 2,500 calories per day, the client should consume how many calories daily during the lactation period?

A)2,800 calories per day.
B)3,000 calories per day.
C)2,200 calories per day.
D)2,700 calories per day.

Question 39

A client who intends to breastfeed after the birth has a Caesarean delivery. Which of the following instructions is the most effective for a client who wants to breastfeed after a Caesarean delivery?

A)"Use the football hold when breastfeeding."
B)"Choose the position that is most comfortable during breastfeeding."
C)"Breast feeding is withheld for the first 12 hours of life."
D)"Breastfeed the newborn every four to eight hours."

Question 40

A client at 20 weeks' gestation asks the doula if she will be able to breastfeed her baby after birth. The client has a history of type 2 diabetes, which has been well controlled both before and during the pregnancy. The client has a BMI of 34. Which of the following statements by the doula is the most appropriate?

A)"Whether or not you can breastfeed your baby will depend on your blood glucose levels after birth."
B)"Mothers with type 2 diabetes are encouraged to breastfeed their babies after birth. Breastfeeding may also lower your need for insulin."
C)"You may not breastfeed your baby after birth. Insulin can cross into the breast milk and may cause your baby to develop hypoglycemia. Your baby may be nourished with formula milk."
D)"Breastfeeding is encouraged for women with type 2 diabetes. However, you may need to increase your insulin when nursing."

Question 41

A doula is creating a teaching plan for a first-time pregnant client at 12 weeks' gestation. The doula focuses on breast care once colostrum secretion begins. Which of the following teachings is not included in the teaching plan?

A)Wash the breasts with clear tap water and mild soap daily.
B)Wear a firm, supportive bra with wide straps.
C)A larger bra may be needed halfway through the pregnancy.
D)If colostrum secretion is excessive, gauze squares or commercial breast pads may be placed inside the bra.