P-IBCLC BFHL-20

P-IBCLC BFHL-20-P01 A breastfed infant being prepared for surgery will be required to fast beforehand for ________ hours, ________.

4 / to reduce the risk of aspirating fluid into the lungs.
2 / as short a time as possible to avoid dehydration and hyperglycemia.
6 / as short a time as possible to avoid dehydration and hyperglycemia.
6 / to reduce the risk of aspirating fluid into the lungs.

P-IBCLC BFHL-20-P02 As compared with manufactured baby milk, breastmilk promotes healthy growth in infants born with cystic fibrosis because it:

Increases the infant’s appetite, so that he or she consumes more breastmilk.
Contains much more milk lipase, which helps the infant better absorb fats.
Promotes absorption of vitamin D and calcium, which increase rate of lengthening.
Remains in the infant’s stomach and small intestine longer, allowing more nutrients to be absorbed.

P-IBCLC BFHL-20-P03 A newborn infant with Pierre Robin Sequence is unlikely to feed well at the breast because they typically have:

Difficulty maintaining his or her airway.
Occluded nares.
A large protruding chin.
Tongue positioned in the front of the mouth.

P-IBCLC BFHL-20-P04 It is now thought that the best way for breastfeeding mothers to reduce the incidence of food allergies in their infants is to:

Avoid consuming food allergens during pregnancy.
Gradually introduce food allergens to the infant once solids have been added to his or her diet.
Feed a non-soy-based hypoallergenic formula.
Breastfeed exclusively and avoid consuming food allergies while breastfeeding.

P-IBCLC BFHL-20-P05 The most important thing to teach a mother whose infant does not suck well is how to:

Express as much milk as possible for her infant.
Let her milk dry up, because the infant cannot gain adequately on breastmilk.
Use feeding-tube devices that provide milk more easily to her infant.
Bottle-feed in ways that mimic breastfeeding.

P-IBCLC BFHL-20-P06 It is ________ necessary to interrupt breastfeeding during the ________ phase of illness.

Sometimes / rehydration (but not recovery).
Sometimes / recovery (but not rehydration).
Almost always / rehydration or recovery.
Never / rehydration or recovery.

P-IBCLC BFHL-20-P07 The projectile vomiting that commonly accompanies uncorrected pyloric stenosis may lead to:

Apnea.
Electrolyte imbalance.
Severe weight gain in the infant.
A placid baby.

P-IBCLC BFHL-20-P08 An infant is more likely to require hospitalization to treat a rotavirus infection if he or she is:

Breastfed.
Not breastfed.
Not in daycare.
An only child.

P-IBCLC BFHL-20-P09 The most common cause of acute lower respiratory infection is respiratory syncytial virus. Which of the following is a characteristic of the illness?

Antibiotics being typically used to treat the primary infection.
The absence of coughing.
It is usually self-limited.
More likely in breastfed infants.

P-IBCLC BFHL-20-P10 A small, isolated cleft of the soft palate in a breastfed infant is:

Usually identified by a staff physician during assessment of the infant shortly after birth.
Associated with a rotund infant.
Of little concern because the breast fills the infant’s mouth.
Known to prevent the infant from generating the suction that obtains milk from the breast.

P-IBCLC BFHL-20-P11 Which of the following items best characterizes respiratory infections?

They are the third most common cause of illness in infants.
The incidence decreases directly with the number of contacts outside the home.
Exclusive but not partial breastfeeding reduces the likelihood of hospitalization for a respiratory illness.
Breastfeeding helps protect against respiratory infections.

P-IBCLC BFHL-20-P12 Infants with celiac disease can be characterized by:

Chronic diarrhea and failure to thrive in response to cow-milk proteins.
An initial display of symptoms when gluten-containing solids are introduced.
Retention of fat-soluble vitamins.
A quicker onset when breastfed.

P-IBCLC BFHL-20-P13 Celiac disease in an at-risk infant is best delayed by breastfeeding:

As long as possible combined with late introduction of solids.
Exclusively for about 8 months, then introducing solids that may include gluten.
Exclusively about 4 months, then introducing formula but delaying solids.
Such that foremilk intake is increased to provide enough calories to compensate for reduced hindmilk intake.

P-IBCLC BFHL-20-P14 Allergic reactions in an exclusively breastfed baby are most likely a response to:

Breastmilk itself.
Fats in the breastmilk, which reflect maternal diet.
Inhalants or topical substances.
Foreign proteins in the breastmilk.

P-IBCLC BFHL-20-P15 One of breastfeeding’s benefits is that it reduces the risk of infection:

If the baby is exclusively breastfed.
Of minor infections even though generally not of major infections.
Principally in warm, impoverished regions.
In direct relation to the proportion of breastmilk taken by the infant.

P-IBCLC BFHL-20-P16 Breastmilk intake by an infant with cleft palate can be maximized by positioning the infant so that he or she is:

In a cross-cradle hold.
Held upright.
Prone on mother’s chest.
Side-lying.

P-IBCLC BFHL-20-P17 As compared with similar babies who were bottle-fed, babies born with a congenital heart defect who were breastfed grew better because they:

Had lower oxygen saturation during feedings.
Ingested a higher fat and thus higher calorie milk.
Expended less energy during a feeding.
Ingested a larger volume of milk.

P-IBCLC BFHL-20-P18 As compared with similar infants who receive no breastmilk, infants with phenylketonuria whose diet includes some breastmilk have been shown to score _________ on tests of intelligence.

About 12 points higher.
4 or 5 points higher.
4 or 5 points lower.
About the same.

P-IBCLC BFHL-20-P19 Gastroesophageal reflux episodes can be minimized by ________.

Feeding at longer intervals.
Feeding on the same breast for several feedings in a row to minimize lactose-rich foremilk and to transfer more high-calorie hindmilk.
Positioning the infant horizontally for feedings to reduce pressure on his or her abdomen.
Putting the infant to sleep on his or her right side to reduce pressure on his esophagus.

P-IBCLC BFHL-20-P20 A bottle nipple used to provide supplements to a breastfed infant should have:

Rapid flow obtained with little negative pressure.
A narrow base.
A hard texture like that of the breast.
A long enough teat that it seats deep in the baby’s mouth, but does not make him or her gag.

P-IBCLC BFHL-20-P21 The best predictor of which young infants will later develop allergies is:

Mother’s diet during pregnancy was high in known allergens.
One or both parents have persistent allergies.
The infant is living in a dwelling several decades old.
The infant is living in a damp climate.

P-IBCLC BFHL-20-P22 A degree of dehydration that should be treated medically (weight loss greater than 9% of previous body weight) is indicated by the joint appearance of:

Gently pinched skin that retracts very quickly.
Moist mucous membranes.
A listless, ill appearance.
Bowed legs.

P-IBCLC BFHL-20-P23 Positioning an infant upright for breastfeeds typically will:

Decrease the force of a milk ejection because the nipple is held more forward in the baby’s mouth.
Decrease milk flow because the nipple usually points upward.
Increase his or her alertness by stimulating the baby’s vestibular system.
Tire the infant because his or her jaw lacks support.

P-IBCLC BFHL-20-P24 Immediately following surgery to correct a cleft lip, a breastmilk-fed infant should best begin feeding by taking milk from a:

Bottle containing breastmilk.
Breast or a soft bottle containing breastmilk.
Dropper or syringe.
Small, soft cup.

P-IBCLC BFHL-20-P25 A nursing 2-year-old has gastroenteritis severe enough to cause moderate dehydration. The best outcome will be obtained by feeding him or her oral rehydration solution and:

Bland diet such as banana, rice, applesauce, and toast.
Sweetened drinks, to encourage consumption of fluids.
Breastmilk and his or her usual table foods, to maintain nutritional status.
Nothing else, to rest his or her intestinal tract.

P-IBCLC BFHL-20-P26 To maximally reduce the phenylalanine load in infants born with phenylketonuria, those infants should be fed:

Exclusively breastmilk.
Exclusively low-phenylalanine manufactured baby milk.
A manufactured baby milk that contains no phenylalanine, combined with breastmilk.
Standard infant formula combined with phenylalanine-free manufactured baby milk.

P-IBCLC BFHL-20-P27 Infants who regurgitate stomach contents several times each day:

Should be placed on their stomachs after feedings.
Have an especially relaxed upper esophageal sphincter.
Are more likely to be exclusively breastfed than receiving mixed feedings.
Are healthy and normal as long as they are happy and gaining weight well.

P-IBCLC BFHL-20-P28 For infants who will be unable to feed directly from the breast for several weeks or more, the most effective way to get milk into them is by use of:

Feeding bottle.
Cup feeding.
Syringe feeding.
Finger feeding.

P-IBCLC BFHL-20-P29 A mother who is bottle-feeding her infant can retain some aspects of breastfeeding by:

Gently introducing the bottle nipple into the baby’s mouth.
Having others bottle-feed the baby.
Allowing the baby to hold the bottle and sit up on his/her own.
Maintaining eye contact with her infant.

P-IBCLC BFHL-20-P30 Which of the following conditions in an infant may contraindicate any breastfeeding, even though it is safe for a woman with the same condition to breastfeed?

Celiac disease.
Chylothorax.
Cystic fibrosis.
Galactosemia.

P-IBCLC BFHL-20-P31 Infants with a stomach and intestinal infection (gastroenteritis) are at greater risk of electrolyte imbalance if families have been supplementing the child’s diet with:

High carbohydrate foods.
High protein foods.
Very-low sodium foods.
High potassium foods.

P-IBCLC BFHL-20-P32 A breastfeeding neonate who has congenital heart disease is likely to:

Nurse steadily for the duration of the feed.
Maintain a pink flush to the skin.
Alternate vigorous suckling with long pauses.
Breathe slowly and regularly.

P-IBCLC BFHL-20-P33 A child who is feeling ill commonly will have a reduced appetite and will nurse:

For long periods at the breast.
More vigorously.
More often for longer periods of time.
More frequently but for a shorter time.

P-IBCLC BFHL-20-P34 A hospital pediatric unit that encourages breastfeeding will:

Encourage 24-hour rooming-in of parents with their ill child.
Allow the mother to express breastmilk two times every 12 hours.
Adhere closely to scheduled nursing procedures so parents will have a structure to work within.
Facilitate restricted breastfeeding.

P-IBCLC BFHL-20-P35 Neonates who show no adverse reaction to a feeding of cow-based manufactured milk in the hospital:

Are too young to develop allergic reactions.
Will never be allergic to cow milk.
Will not develop any allergic reaction if all subsequent feedings are cow-milk-based formulas.
May express allergic symptoms later if they subsequently ingest cow-milk-based fluids.

P-IBCLC BFHL-20-P36 A baby born with cleft lip (and no cleft palate) can usually breastfeed if:

Maternal finger is used to help seal the cleft as he or she latches onto the breast.
He or she is interested, but that is the exception rather than the rule.
He or she is swaddled to prevent pulling away from the breast.
His or her cleft is visible when nursing in cradle position.

P-IBCLC BFHL-20-P37 After surgery to correct pyloric stenosis, breastfeeding may resume:

After a 24-hour fast to allow the incision site to begin healing.
After glucose-water feedings are well tolerated.
By using brief breastfeeds gradually lengthened during the first 72 hours after surgery.
As soon, as long, and as often as the baby desires.

P-IBCLC BFHL-20-P38 Families of infants born with chronic medical problems most appreciate advice that is:

Detailed, so that all information is available at once.
Focused on the here and now, rather than on future eventualities.
Accurate, so they can develop realistic goals.
Given tactfully, out of consideration for the parents’ stressful situation.

P-IBCLC BFHL-20-P39 Following surgery, a breastfed infant may resume feeding from the breast after:

12 hours.
24 hours.
The physician approves any oral feeding.
An initial glucose-water feeding.

P-IBCLC BFHL-20-P40 A breastfed infant in whom an ear infection has developed will likely be more comfortable if he or she is fed _________, because ________.

In an upright position / it minimizes pressure and discomfort in the middle ear.
At longer intervals for longer times / so doing minimizes handling of the baby.
In a supine position / the ill infant expends less energy.
Only when he or she will not accept a pacifier / the pacifier better calms the infant.

P-IBCLC BFHL-20-P41 Breastfeeding an infant during a painful procedure such as a heel stick has the effect of:

Reducing the baby’s crying.
Causing the baby to shut down.
Increasing the baby’s heart rate.
Increasing the baby’s pain score.

P-IBCLC BFHL-20-P42 Jaundice in the newborn infant may be caused by:

Galactosemia.
Hyperthyroidism.
Decreased hemolysis of fetal blood cells.
Diabetes (type 1).

P-IBCLC BFHL-20-P43 Infants born with MM or Chiari II malformation typically have difficulty breastfeeding because:

There are no holds that can help the child to breastfeed.
They do not have a functioning gag reflex.
The downward displacement of the brain damages nerves employed in suck and swallow.
They typically undergo prenatal surgical correction of malformations.

P-IBCLC BFHL-20-P44 Down syndrome children may or may not have difficulty initiating breastfeeding. Which of the following characteristics influences breastfeeding difficulty?

Small, non-protruding tongue.
Epicanthal folds.
High muscle tone.
Associated congenital heart disease.

P-IBCLC BFHL-20-P45 For a breastfed infant who currently requires some or all of his or her feedings by bottle, the caregiver should:

Continue feeding the baby until the bottle is empty.
Hold the feeding bottle vertically.
Tip the baby forward (bottle nipple points slightly up) to allow baby to rest as needed.
Tip the baby backward (base of bottle points slightly up) to allow milk to flow without effort on the baby’s part.

P-IBCLC BFHL-20-P46 Both hypotonic and hypertonic infants are most likely to obtain more milk at the breast if the mother:

Uses a tube-feeding device at the breast.
Massages her breasts before and during a feeding.
Wears breast shells between feedings.
Uses a thin silicone nipple shield during feedings.

P-IBCLC BFHL-20-P47 Breastmilk thickened with cereal, fed by bottle to an infant with gastroesophageal reflux disease, is a __________ idea because __________.

Good / thickened feedings increase coughing by the infant.
Good / thicker stomach fluids stick longer to the walls of the esophagus.
Poor / enzymes in breastmilk quickly break down the thickening agents.
Poor / the number of reflux episodes increases.

P-IBCLC BFHL-20-P48 The best predictor of duration of any breastfeeding by an infant with congenital heart defects is the:

Infant’s birth weight.
Innate oral-motor coordination of the infant.
Severity of the defect.
Mother’s determination to continue.

P-IBCLC BFHL-20-P49 A breastfed infant with moderate to severe congenital heart disease commonly gains weight ________ , because _________.

Poorly or not at all / of a high respiratory rate.
Poorly or not at all / of a slow heart rate.
Slowly but steadily / breastmilk is metabolized with almost no waste.
Slowly but steadily / of the stimulant effect of extra stress hormones in his or her system.

P-IBCLC BFHL-20-P50 Diagnosis of Pierre Robin Sequence typically occurs:

At about one year of age.
Shortly after birth.
Between 3-6 months of age.
Prior to birth.

P-IBCLC BFHL-20-P51 A good time to offer the breast to a slow-gaining breastfed infant is when the infant is ________ because then he or she _________.

Crying / will have his or her mouth wide open.
Fussing / probably is hungry.
Sleeping soundly / is unlikely to resist.
Awake but quiet / will be most receptive.

P-IBCLC BFHL-20-P52 Although it is not known whether breastfeeding in fact protects infants from type 1 diabetes, a proposed mechanism is that it:

Increases gut permeability, as compared to cow milk products, which decrease permeability.
Has a larger proportion of lipids, as compared to cow milk products.
Delays exposure to cow-milk protein.
Increases the risk of enteroviral infections.

P-IBCLC BFHL-20-P53 The nutrient and calorie intake of a debilitated infant is best increased by feeding mother’s milk:

At the breast while the mother massages milk into the baby’s mouth.
That has had some of the fat removed.
That has some of the carbohydrates removed.
In a nasogastric tube for bolus or continuous feedings.

P-IBCLC BFHL-20-P54 Excessively low muscle tone (hypotonia) can express itself in a breastfeeding infant by:

An easily stimulated gag reflex.
Generation of little negative pressure during suck.
Complete seal of lips on the breast.
Steady tongue peristalsis.

P-IBCLC BFHL-20-P55 A breastfed baby with congenital heart disease is likely to feed better in a position that:

Extends his or her torso.
Flexes his or her knees.
Hyperextends his or her neck.
Tips his or her chin down.

P-IBCLC BFHL-20-P56 Transient lactase deficiency in a breastfed infant’s intestinal brush border may be preceded by:

Administration of antibiotics.
Using one breast at each feeding.
Respiratory illness.
Administration of analgesics.

P-IBCLC BFHL-20-P57 Which of the following indicates excessively high muscle tone (hypertonia)?

Thrust or retracted tongue.
Breast falling to the back of the infant’s mouth.
Straightening of the back.
Absence of a gag reflex.

P-IBCLC BFHL-20-P58 A baby with a respiratory infection can be helped to breastfeed more easily by use of a(n):

Antihistamine or decongestant to open bronchial passages.
Upright position during breastfeeds to help him or her breathe.
Saline drops to stimulate his or her appetite.
Warm-air vaporizer to loosen nasal secretions.

P-IBCLC BFHL-20-P59 Which of the following describes breastfed babies during or after an acute illness?

They are more likely to be hospitalized than babies fed manufactured baby milk.
They tend to gain more weight than babies fed manufactured baby milk.
They should not, at a later date, be fed milk expressed during their illness.
They should continue to be breastfed insofar as they are able.

P-IBCLC BFHL-20-P60 In all 50 states of the United States, newborns must be screened for:

Phenylketonuria and congenital hypothyroidism.
Congenital hypothyroidism and galactosemia.
Galactosemia and cystic fibrosis.
Cystic fibrosis and phenylketonuria.

P-IBCLC BFHL-20-P61 Normal weight gain in an infant with cleft palate (alone or with cleft lip) is rare, because the baby typically has difficulty:

Generating the negative pressure that helps expel milk from the breast.
Maintaining a favorable upright position.
Maintaining a normal appetite.
Staying awake at the breast.

P-IBCLC BFHL-20-P62 Mothers who wish to reduce the likelihood that their infant or young child will develop an infection of the middle ear will ensure:

Cessation of any amount of breastfeeding.
Avoidance of cigarette smoke.
Continuation of pacifier use into the second half of the first year.
Enrolling the child in daycare.

P-IBCLC BFHL-20-P63 In a child not gaining adequate weight, before-feeding and after-feeding test weights that show good intake for age are best interpreted to mean that:

The scales probably need to be recalibrated.
The mother’s milk contains too little fat.
The baby obtains too much foremilk and not enough hindmilk.
After meeting his or her metabolic demands, not enough calories remain for the infant to grow well.

P-IBCLC BFHL-20

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