Nutrition Through the Life Cycle 6th Edition by Judith E. Brown – Test Bank +A

Description

Key to question information: ANS = correct answer; DIF = question difficulty; REF = page reference; OBJ = chapter learning objective for question section

Learning Objectives

6.1 Describe the development, the structure, and the functional components of the mammary gland. Describe the key hormonal influences on development and function.

6.2 Identify similarities and differences in nutrient levels between colustrum and mature human milk, and between mature human milk, whole cow’s milk, and human milk substitutes (infant formula).

6.3 Summarize the benefits of breastfeeding for mothers and their babies in a manner that could be included in breastfeeding education for expecting mothers, their partners, and family members.

6.4 Generate an education plan for new mothers that includes the answers to common questions about milk supply including what is typical milk production, what is the relationship between infant demand and maternal supply, and the influence of the size of the breast, feeding frequency, pumping, and breast surgeries on milk production.

6.5 Describe maternal steps to prepare the breast, and the basic position of the infant at the breast.

6.6 Describe infant behaviors that indicate readiness to feed, and vitamin supplement recommendations for breastfeeding infants.

6.7 First, identify the professional and government sources of nutrient recommendations for healthy women for diet and supplements. Second list common nutrition diagnoses for breastfeeding women coupled with nutrition intervention and appropriate parameters for monitoring.

6.8 Identify at least two breastfeeding promotion programs that have demonstrated effectiveness at increasing breastfeeding initiation and duration.

6.9 Summarize factors known to be associated with higher and lower rates of breastfeeding, and the gap between current rates and the Breastfeeding Goals for the United States.

Multiple Choice

1. The hormone responsible for uterine contractions and the minimization of maternal postpartum blood loss is:
2. prolactin.
3. oxytocin.
4. estrogen.
5. progesterone.
6. testosterone.

ANS: b DIF: Fact-based REF: 172 OBJ: 6.3

1. Which of the following is NOT a maternal benefit of breastfeeding?
2. Minimizes postpartum blood loss
3. Helps uterus return to nonpregnant size
4. Delays return to fertility
5. MAY help lose weight more quickly
6. All of the above would be considered benefits of breastfeeding.

ANS: e DIF: Fact-based, easy REF: 172 OBJ: 6.3

1. Maternal psychological benefits related to breastfeeding include all the following EXCEPT:
2. increased self-confidence.
3. bonding with the breast fed infant.
4. a slower return to pre-pregnancy weight.
5. All of the above are psychological benefits.

ANS: c DIF: Fact-based REF: 172 OBJ: 6.3

1. Which of the following is a nutritional benefit of breastfeeding?
2. It provides optimal nutrition to the infant.
3. The balance of nutrients matches requirements needed for human growth.
4. Infants do not need additional fluids or water when breastfeeding.
5. The low protein content is easily tolerated.
6. All of the above are considered nutritional benefits.

ANS: e DIF: Fact-based REF: 172 OBJ: 6.3

1. Which statement is FALSE in regards to preparation for breastfeeding?
2. Gentle massage is recommended to get accustomed to handling the breasts and prepare them for expressing milk.
3. Rubbing the breast with a towel is recommended to toughen the breast.
4. The Hoffman technique is used for women with flat or inverted nipples.
5. Natural lubrication is produced by the Montgomery glands by the third trimester.
6. All of the above are true.

ANS: b DIF: Fact-based; hard REF: 176 OBJ: 6.5

1. Several mechanisms that may prevent obesity in children who are breastfed have been identified. These include all of the following EXCEPT:
2. children that breastfed exhibited less soft drink consumption as teens.
3. children that breastfed learned self-regulation of energy intake.
4. children that breastfed shared characteristics of parents, including healthy lifestyles.
5. children that breastfed had metabolic programming related to chemical substances in human milk.
6. All of the above are potential protective mechanisms.

ANS: a DIF: Fact-based REF: 174 OBJ: 6.3

1. Breastfeeding rates are highest in _____ and lowest in _____.
2. eastern states; the Midwest
3. southern states; eastern states
4. western states; southern states
5. southern states; western states
6. the Midwest; southern states

ANS: c DIF: Fact-based REF: 186 OBJ: 6.9

1. An urban community wants to decrease ethnic and racial disparities in early postpartum breastfeeding rates. Which ethnic group would most likely have the greatest potential for increased breastfeeding rates?
2. African American women
3. White women
4. Hispanic women
5. Asian women
6. Latina women

ANS: a DIF: Application-based, easy REF: 186 OBJ: 6.9

1. The goal set for 2020 is for at least _____% of women to ever breastfeed their infants.
2. 25
3. 50
4. 75
5. 82
6. 90

ANS: d DIF: Fact-based REF: 186 OBJ: 6.9

1. Healthy People 2020 breastfeeding objectives for the nation include increasing the number of all women who exclusively breastfeed through six months to approximately _____%.
2. 25
3. 45
4. 50
5. 75
6. 100

ANS: a DIF: Fact-based, easy REF: 186 OBJ: 6.9

1. The cyclic release of what 2 hormones governs pubertal breast development?
2. Prolactin and oxytocin
3. Progesterone and estrogen
4. Prolactin and estrogen
5. Progesterone and oxytocin
6. Testosterone and progesterone

ANS: b DIF: Fact-based REF: 165 OBJ: 6.1

1. The functional units of the mammary gland are the:
2. lobules.
3. myoepithelial cells.
4. alveoli.
5. areolas.
6. secretory cells.

ANS: c DIF: Fact-based, hard REF: 165 OBJ: 6.1

1. Milk “comes in” during which stage of lactogenesis?
2. Lactogenesis I
3. Lactogenesis II
4. Lactogenesis III
5. Lactogenesis IV
6. Lactogenesis V

ANS: b DIF: Fact-based REF: 166 OBJ: 6.1

1. What hormone is necessary for the let-down reflex?
2. Oxytocin
3. Prolactin
4. Estrogen
5. Progesterone
6. Both c and d

ANS: a DIF: Fact-based, easy REF: 167 OBJ: 6.1

1. Control of the amount of milk produced is regulated by _____.
2. how strongly an infant suckles
3. how often an infant suckles
4. how many infants are fed
5. how much milk is removed from the breast
6. Both c and d

ANS: e DIF: Application-based, medium REF: 175 OBJ: 6.4

1. A petite Southeastern Asian woman was not planning to breastfeed because she felt her breasts were so small that they would not produce enough milk. What information would be the best information for her to know?
2. Inadequate food intake by the mother decreases the quantity of milk, not the quality.
3. Small breasts would be able to meet infant demands and only store less milk, thus leading to more feedings.
4. Eating a rice and fruit diet would best support adequate milk production.
5. Drinking more water and milk products would make up for the smaller breast tissue.

ANS: b DIF: Application-based, medium REF: 175 OBJ: 6.4

1. On the second feeding after birth, a first-time mom was concerned that her infant was not getting enough milk. What would the lactation consultant want the new mom to know?
2. The first milk is highly concentrated in nutrients and provides a large amount of protein.
3. The infant needs only ½ to 2 tsp at each feeding for the first two days.
4. The infant needs human milk substitutes to ensure adequate energy intake.
5. The infant needs supplemental sugar water to ensure adequate energy intake.
6. a and b

ANS: e DIF: Application-based, medium REF: 168 OBJ: 6.2

1. Breast milk is isosmotic, which means breast milk _____.
2. contains milk proteins
3. has the same concentration of molecules as the mother’s body plasma
4. has the same concentration of molecules as human milk substitutes
5. has a greater concentration of molecules than human milk substitutes

ANS: b DIF: Fact-based, medium REF: 172 OBJ: 6.3

1. The major component of breast milk is _____, while the second largest component is _____.
2. water, lipids
3. lipids, water
4. protein, carbohydrate
5. carbohydrate, protein
6. protein, lipids

ANS: a DIF: Fact-based REF: 168 OBJ: 6.2

1. The dominant carbohydrate in human milk is _____.
2. galactose
3. glucose
4. lactose
5. sucrose
6. maltose

ANS: c DIF: Fact-based, easy REF: 170 OBJ: 6.2

1. The major class of protein found in mature human milk is:
2. whey.
3. casein.
4. lactose.
5. maltose.
6. colostrum.

ANS: b DIF: Fact-based REF: 170 OBJ: 6.2

1. Protein content in human milk is affected by the _____.
2. age of the infant
3. amount of protein in the mother’s diet
4. hormone variation in the mother
5. All of the above
6. a and c only

ANS: e DIF: Fact-based, hard REF: 170 OBJ: 6.2

1. Because human infants grow at a relatively slow rate, the mineral content of human milk is _____ that of other animals who grow faster.
2. lower than
3. higher than
4. equal to
5. half of

ANS: a DIF: Application-based REF: 171 OBJ: 6.2

1. What fat-soluble vitamin is given to infants at birth?
2. Vitamin A
3. Vitamin D
4. Vitamin E
5. Vitamin K

ANS: d DIF: Fact-based, easy REF: 171 OBJ: 6.2

1. It is recommended that women allow infants to drain one breast completely before offering the other breast primarily because:
2. this allows them to get more foremilk, which may decrease incidence of diarrhea and prevent colic.
3. this allows them to get both foremilk and hindmilk, which may decrease incidence of diarrhea.
4. this prevents excess gas from forming.

ANS: b DIF: Fact-based REF: 178 OBJ: 6.6

1. The 2002 DRI for lactating women is _____ additional calories per day during the first 6 months with a 0.8 kg per month weight loss.
2. 200
3. 330
4. 500
5. 650
6. unlimited

ANS: b DIF: Fact-based REF: 181 OBJ: 6.7

1. What nutrient forms a soft, easily digestible curd in the baby’s stomach?
2. Copper
3. Vitamin K
4. Whey
5. Casein
6. Iron

ANS: c DIF: Fact-based, medium REF: 172 OBJ: 6.3

1. A health care professional was asked by a nursing mom, “How many glasses of water should I drink a today?” What would be an appropriate recommendation?
2. 6-8 glasses
3. 8-10 glasses
4. >10 glasses
5. Drink enough fluids to keep your urine pale yellow.

ANS: d DIF: Application-based, medium REF: 184 OBJ: 6.7

1. Which of the following is NOT a common barrier to breastfeeding initiation?
2. Embarrassment
3. Lack of confidence
4. Fear of pain
5. Lack of support
6. All of the above are common barriers to breastfeeding.

ANS: e DIF: Fact-based REF: 185-186 OBJ: 6.9

1. Barriers to breastfeeding and employment have been recognized by the U.S. Surgeon General; these barriers include all of the following EXCEPT:
2. lack of on-site day care.
3. embarrassment.
4. insufficiently paid maternity leave.
5. rigid work schedules.
6. employers that lack knowledge about breastfeeding.

ANS: b DIF: Fact-based REF: 191 OBJ: 6.8

1. A low-income mom began breastfeeding in the hospital and was discharged with a healthy infant. The critical time for a public health nurse to visit after discharge (which would improve the likelihood of continuing breastfeeding) is _____ after discharge.
2. 5-7 days
3. 7-10 days
4. 14-21 days
5. 3 months

ANS: b DIF: Application-based, medium REF: 191 OBJ: 6.8

1. Which of the following correctly describes the current status of breastfeeding in the United States?
2. Women are meeting the Healthy People 2020 goals for breastfeeding initiation, but not for breastfeeding at 6 and 12 months.
3. Women are meeting the Healthy People 2020 goals for breastfeeding initiation and breastfeeding at 6 months, but not for 12 months.
4. Women are meeting all the Healthy People 2020 goals for breastfeeding; therefore there is discussion of revising the goals to set a higher target.
5. Women in the south are not meeting any of the Healthy People 2020 breastfeeding objectives.

ANS: d DIF: Fact-based REF: 186 OBJ: 6.9

1. Which correctly describes the Healthy People 2020 breastfeeding goals?
2. 82% of mothers initiating breastfeeding, 61% of mothers breastfeeding at 6 months, and 34% of mothers breastfeeding at 12 months
3. 75% of mothers initiating breastfeeding, 50% of mothers breastfeeding at 6 months, and 25% of mothers breastfeeding at 12 months
4. 100% of mothers initiating breastfeeding, 55% of mothers breastfeeding at 6 months, and 22% of mothers breastfeeding at 12 months
5. None of the above

ANS: a DIF: Fact-based REF: 186 OBJ: 6.9

1. Shelly is a 25-year-old breastfeeding mom who is trying to lose weight. Her OBGYN has suggested that she go on a very-low-fat diet (~15% of calories) to help with weight loss. How will this change the fat composition of her breast milk?
2. It will not change the fat composition at all.
3. Her breast milk will contain more very-long-chain fatty acids.
4. Her breast milk will contain more saturated fatty acids.
5. Her breast milk will contain more medium-chain fatty acids.
6. Her breast milk will contain more cholesterol.

ANS: d DIF: Application-based REF: 169 OBJ: 6.2

Use the following information for questions 35-37:

A young woman comes into your office for a lactation consultation complaining that her 1-month-old baby is colicky and slow to gain weight. Her baby requires 6 to 7 diaper changes each day and suffers from diarrhea. She tells you she allows the baby to nurse equally on each breast so that she does not feel “overfull”; she is desperate for help and asks your advice on what to do. A 24-hour diet history provides the following information about her eating habits.

Breakfast: cereal, milk, banana, and walnut pieces; sometimes she has eggs

Lunch: peanut butter sandwich, salad, and grapes with a glass of milk

Dinner: fish or chicken, vegetables, potato or rice, applesauce, and milk

Snacks: change daily, but she likes trail mix because it is easy to eat when nursing

1. What would the best advice be for this woman?
2. Allow your baby to nurse on one breast only until it is completely empty.
3. Allow us to evaluate you while you are nursing your baby and see what you are doing.
4. Stop nursing immediately and use an infant formula so your baby starts growing.
5. Use supplemental infant formula after each feeding because the baby is obviously not getting enough to eat.
6. a and b only

ANS: e DIF: Application-based REF: 178-179 OBJ: 6.6

1. What is likely happening to this baby and causing the diarrhea?
2. The baby is not latched on properly.
3. The mother is not producing enough breast milk.
4. The baby is getting too much foremilk and not enough hindmilk.
5. The baby has a poor suckle.
6. The baby is lactose intolerant.

ANS: c DIF: Application-based REF: 178 OBJ: 6.6

1. After looking at her diet, what changes could you suggest to help with the baby’s colic?
2. Eliminate all fruit except canned fruit
3. Eliminate nuts
4. Eliminate dairy products
5. All of the above
6. b and c only

ANS: e DIF: Application-based REF: 184 OBJ: 6.7

1. A nursing mother is given a diaper bag full of formula samples and coupons by her nurse upon discharge from the hospital. What is the nurse telling her?
2. She has been a great patient and her nurse wants to give her a gift.
3. The nurse wants to make sure she can get a discount on formula should she decide to try it instead of breastfeed.
4. The nurse knows she is returning to work and will need to supplement the baby’s diet.
5. The nurse is letting her know that formula is just as good as breast milk.
6. Both b and c

ANS: d DIF: Application-based REF: 189 OBJ: 6.8

1. Is it normal for colostrum to be green?
2. Yes; colostrum is the first milk and is always green.
3. No; this definitely sounds wrong; you should talk to you doctor about it.
4. The green color will clear up if you continue to nurse.

ANS: b DIF: Fact-based REF: 168 OBJ: 6.2

1. Continuing to nurse while you are sick actually protects your baby because:
2. you do not pass germs through breast milk.
3. your breast milk is full of antibodies that are passed on to your baby.
4. you do not contaminate bottles by handling them.
5. infant formulas are higher in vitamins and minerals and help boost the baby’s immune system.

ANS: b DIF: applications-based REF: 173 OBJ: 6.3

1. A baby that is not given vitamin K at birth may have:
2. excessive bleeding due to a lack of blood clotting.
3. decreased calcium absorption.
4. increased incidence of colic.
5. increased incidence of diarrhea.
6. All of the above

ANS: a DIF: Application-based REF: 181 OBJ: 6.6

1. What would be the best response to a new mother who asks you: “My baby is two months old and I just started working again part time; I pump once at work every day, and get between two and three ounces. Is this enough?”
2. It depends on how much your baby drinks.
3. You will need to pump or nurse every 2-3 hours to maintain your supply.
4. It is imperative that you are consistent with pumping and feeding.
5. All of the above

ANS: d DIF: Application-based REF: 175 OBJ: 6.4

True/False

1. One of the key messages of the WIC Best Start campaign is the involvement of family and friends to make breastfeeding a success.

ANS: T DIF: Fact-based, difficult REF: 193 OBJ: 6.8

1. When breastfeeding, you should hear a smacking or clicking sound which indicates the baby is getting milk.

ANS: F DIF: Fact-based, easy REF: 177|178 OBJ: 6.5|6.6

1. As of 2012 breastfeeding rates are continuing to rise.

ANS: T DIF: Fact-based, easy REF: 186 OBJ: 6.9

1. Breastfeeding women on a vegetarian diet tend to get plenty of protein as long as their energy intakes are adequate.

ANS: T DIF: Application-based, medium REF: 184 OBJ: 6.7

1. Breastfeeding has been found to be just as effective as other methods of birth control, such as the birth control pill.

ANS: F DIF: Fact-based REF: 172 OBJ: 6.3

1. Breastfeeding may be used to reduce infant discomfort during minor invasive procedures.

ANS: T DIF: Fact-based REF: 174 OBJ: 6.3

1. In the early 1900s almost all infants in the U.S. were breastfed.

ANS: T DIF: Fact-based REF: 186 OBJ: 6.9

1. Letdown ONLY occurs when the infant suckles the breast.

ANS: F DIF: Application-based REF: 167 OBJ: 6.1

1. The size of a woman’s breast limits her ability to STORE milk.

ANS: T DIF: Fact-based REF: 175 OBJ: 6.4

1. Infants appear to be interested in their mother’s milk when flavors are new to them.

ANS: T DIF: Fact-based REF: 172 OBJ: 6.2

Matching

1. Colostrum 2. Secretory immunoglobulin A 3. Prolactin 4. Oxytocin 5. Alveoli 6. Secretory cells 7. Myoepithelial cells 8. Lobes 9. Lactogenesis 10. Foremilk 11. Hindmilk

A. cells in the milk gland that are responsible for secreting milk components into the ducts B. rounded or oblong-shaped cavities in the breast C. rounded structures of the mammary gland D. milk at the end of feeding that contains a higher amount of human milk fat E. milk at the beginning of a feeding that contains a lower amount of human milk fat F. specialized cells that line the alveoli and contract to cause milk to be secreted into the duct G. one of the primary proteins present in colostrum H. hormone secreted by the pituitary that causes milk “let down” I. hormone secreted by the pituitary that stimulates milk production J. the thick, yellow fluid produced in the first 2-3 days after birth, high in protein K. another term for milk production

Key:

1. ANS: J DIF: Fact-based REF: 168 OBJ: 6.2
2. ANS: G DIF: Fact-based REF: 168 OBJ: 6.2
3. ANS: I DIF: Fact-based REF: 166 OBJ: 6.1
4. ANS: H DIF: Fact-based REF: 167 OBJ: 6.1
5. ANS: B DIF: Fact-based REF: 165 OBJ: 6.1
6. ANS: A DIF: Fact-based REF: 165 OBJ: 6.1
7. ANS: F DIF: Fact-based REF: 165 OBJ: 6.1
8. ANS: C DIF: Fact-based REF: 165 OBJ: 6.1
9. ANS: K DIF: Fact-based REF: 165 OBJ: 6.1
10. ANS: E DIF: Fact-based REF: 168 OBJ: 6.2
11. ANS: D DIF: Fact-based REF: 168 OBJ: 6.2

Short Answer

1. A congressman wants more information about the success of the Special Supplemental Nutrition Program called “WIC.” Identify four benefits of breastfeeding (maternal or infant) for the congressman. Also, identify one socioeconomic fact that would convince the congressman to support the program.

ANS: See pp. 172-174.

DIF: Application-based, medium REF: 172-174 OBJ: 6.3

1. Identify three reflexes of healthy term infants. Discuss how these help infants obtain adequate nutrients from breastfeeding.

ANS: See pp. 177-178.

DIF: Fact-based, medium REF: 177-178 OBJ: 6.6

1. After her first baby was born, Sue Smith wanted to lose weight before she returned to work in 6 months. She sought nutrition care from a dietitian to set up an eating and exercise plan. Identify three questions that would initiate a discussion about weight loss postpartum.

ANS: See pp. 182-183.

DIF: Application-based, hard REF: 182-183 OBJ: 6.7

1. A rural hospital received the Baby-Friendly Hospital Initiative packet and wanted to promote successful breastfeeding. The first goal was to educate all staff members on ways to communicate the benefits of breastfeeding. Identify at least four verbal and non-verbal examples that hospital staff could implement to establish a “breastfeeding friendly” environment.

ANS: See p. 191.

DIF: Application-based, medium REF: 191 OBJ: 6.8

1. If a friend of yours were to become a breastfeeding mom, would you be able to support her decision to breastfeed? Are there other people that would support her decision? What information would you want to give her? What place would provide the least supportive breastfeeding environment and why?

ANS: See pp. 172-174, 187-193.

DIF: Application-based, hard REF: 172-174|187-193 OBJ: 6.3|6.8

1. Discuss the stand that the American Academy of Pediatrics has taken on breastfeeding, saying that “breastfeeding should continue for a year or longer.” Does this stand differ from what the U.S. Surgeon General advocates? What research would back up either of these statements?

ANS: See p. 185.

DIF: Application-based REF: 185 OBJ: 6.9

1. How does proper positioning of an infant aid in breastfeeding success? Describe techniques that might benefit a mother who is trying to properly position her infant. Explain how a first-time mom would get help with proper positioning.

ANS: See pp. 176-178, 191.

DIF: Application-based REF: 176-178|191 OBJ: 6.5|6.6|6.8

1. What are some factors that would influence the initiation and/or duration of a new mother’s decision to breastfeed? How would you go about encouraging a woman to breastfeed after she has encountered several negative influences?

ANS: See pp. 185-186, 188.

DIF: Application-based REF: 185-186|188 OBJ: 6.8|6.9

Ready-to-Use Chapter 6 Test

Multiple Choice

1. The hormone responsible for uterine contractions and the minimization of maternal postpartum blood loss is:
2. prolactin.
3. oxytocin.
4. estrogen.
5. progesterone.
6. testosterone.

1. Which of the following is NOT a maternal benefit of breastfeeding?
2. Minimizes postpartum blood loss
3. Helps uterus return to nonpregnant size
4. Delays return to fertility
5. MAY help lose weight more quickly
6. All of the above would be considered benefits of breastfeeding.

1. Maternal psychological benefits related to breastfeeding include all the following EXCEPT:
2. increased self-confidence.
3. bonding with the breast fed infant.
4. a slower return to pre-pregnancy weight.
5. All of the above are psychological benefits.

1. Which of the following is a nutritional benefit of breastfeeding?
2. It provides optimal nutrition to the infant.
3. The balance of nutrients matches requirements needed for human growth.
4. Infants do not need additional fluids or water when breastfeeding.
5. The low protein content is easily tolerated.
6. All of the above are considered nutritional benefits.

1. Which statement is FALSE in regards to preparation for breastfeeding?
2. Gentle massage is recommended to get accustomed to handling the breasts and prepare them for expressing milk.
3. Rubbing the breast with a towel is recommended to toughen the breast.
4. The Hoffman technique is used for women with flat or inverted nipples.
5. Natural lubrication is produced by the Montgomery glands by the third trimester.
6. All of the above are true.

1. Several mechanisms that may prevent obesity in children who are breastfed have been identified. These include all of the following EXCEPT:
2. children that breastfed exhibited less soft drink consumption as teens.
3. children that breastfed learned self-regulation of energy intake.
4. children that breastfed shared characteristics of parents, including healthy lifestyles.
5. children that breastfed had metabolic programming related to chemical substances in human milk.
6. All of the above are potential protective mechanisms.

1. Breastfeeding rates are highest in _____ and lowest in _____.
2. eastern states; the Midwest
3. southern states; eastern states
4. western states; southern states
5. southern states; western states
6. the Midwest; southern states

1. An urban community wants to decrease ethnic and racial disparities in early postpartum breastfeeding rates. Which ethnic group would most likely have the greatest potential for increased breastfeeding rates?
2. African American women
3. White women
4. Hispanic women
5. Asian women
6. Latina women

1. The goal set for 2020 is for at least _____% of women to ever breastfeed their infants.
2. 25
3. 50
4. 75
5. 82
6. 90

1. Healthy People 2020 breastfeeding objectives for the nation include increasing the number of all women who exclusively breastfeed through six months to approximately _____%.
2. 25
3. 45
4. 50
5. 75
6. 100

1. The cyclic release of what 2 hormones governs pubertal breast development?
2. Prolactin and oxytocin
3. Progesterone and estrogen
4. Prolactin and estrogen
5. Progesterone and oxytocin
6. Testosterone and progesterone

1. The functional units of the mammary gland are the:
2. lobules.
3. myoepithelial cells.
4. alveoli.
5. areolas.
6. secretory cells.

1. Milk “comes in” during which stage of lactogenesis?
2. Lactogenesis I
3. Lactogenesis II
4. Lactogenesis III
5. Lactogenesis IV
6. Lactogenesis V

1. What hormone is necessary for the let-down reflex?
2. Oxytocin
3. Prolactin
4. Estrogen
5. Progesterone
6. Both c and d

1. Control of the amount of milk produced is regulated by _____.
2. how strongly an infant suckles
3. how often an infant suckles
4. how many infants are fed
5. how much milk is removed from the breast
6. Both c and d

1. A petite Southeastern Asian woman was not planning to breastfeed because she felt her breasts were so small that they would not produce enough milk. What information would be the best information for her to know?
2. Inadequate food intake by the mother decreases the quantity of milk, not the quality.
3. Small breasts would be able to meet infant demands and only store less milk, thus leading to more feedings.
4. Eating a rice and fruit diet would best support adequate milk production.
5. Drinking more water and milk products would make up for the smaller breast tissue.

1. On the second feeding after birth, a first-time mom was concerned that her infant was not getting enough milk. What would the lactation consultant want the new mom to know?
2. The first milk is highly concentrated in nutrients and provides a large amount of protein.
3. The infant needs only ½ to 2 tsp at each feeding for the first two days.
4. The infant needs human milk substitutes to ensure adequate energy intake.
5. The infant needs supplemental sugar water to ensure adequate energy intake.
6. a and b

1. Breast milk is isosmotic, which means breast milk _____.
2. contains milk proteins
3. has the same concentration of molecules as the mother’s body plasma
4. has the same concentration of molecules as human milk substitutes
5. has a greater concentration of molecules than human milk substitutes

1. The major component of breast milk is _____, while the second largest component is _____.
2. water, lipids
3. lipids, water
4. protein, carbohydrate
5. carbohydrate, protein
6. protein, lipids

1. The dominant carbohydrate in human milk is _____.
2. galactose
3. glucose
4. lactose
5. sucrose
6. maltose

1. The major class of protein found in mature human milk is:
2. whey.
3. casein.
4. lactose.
5. maltose.
6. colostrum.

1. Protein content in human milk is affected by the _____.
2. age of the infant
3. amount of protein in the mother’s diet
4. hormone variation in the mother
5. All of the above
6. a and c only

1. Because human infants grow at a relatively slow rate, the mineral content of human milk is _____ that of other animals who grow faster.
2. lower than
3. higher than
4. equal to
5. half of

1. What fat-soluble vitamin is given to infants at birth?
2. Vitamin A
3. Vitamin D
4. Vitamin E
5. Vitamin K

1. It is recommended that women allow infants to drain one breast completely before offering the other breast primarily because:
2. this allows them to get more foremilk, which may decrease incidence of diarrhea and prevent colic.
3. this allows them to get both foremilk and hindmilk, which may decrease incidence of diarrhea.
4. this prevents excess gas from forming.

1. The 2002 DRI for lactating women is _____ additional calories per day during the first 6 months with a 0.8 kg per month weight loss.
2. 200
3. 330
4. 500
5. 650
6. unlimited

1. What nutrient forms a soft, easily digestible curd in the baby’s stomach?
2. Copper
3. Vitamin K
4. Whey
5. Casein
6. Iron

1. A health care professional was asked by a nursing mom, “How many glasses of water should I drink a today?” What would be an appropriate recommendation?
2. 6-8 glasses
3. 8-10 glasses
4. >10 glasses
5. Drink enough fluids to keep your urine pale yellow.

1. Which of the following is NOT a common barrier to breastfeeding initiation?
2. Embarrassment
3. Lack of confidence
4. Fear of pain
5. Lack of support
6. All of the above are common barriers to breastfeeding.

1. Barriers to breastfeeding and employment have been recognized by the U.S. Surgeon General; these barriers include all of the following EXCEPT:
2. lack of on-site day care.
3. embarrassment.
4. insufficiently paid maternity leave.
5. rigid work schedules.
6. employers that lack knowledge about breastfeeding.

1. A low-income mom began breastfeeding in the hospital and was discharged with a healthy infant. The critical time for a public health nurse to visit after discharge (which would improve the likelihood of continuing breastfeeding) is _____ after discharge.
2. 5-7 days
3. 7-10 days
4. 14-21 days
5. 3 months

1. Which of the following correctly describes the current status of breastfeeding in the United States?
2. Women are meeting the Healthy People 2020 goals for breastfeeding initiation, but not for breastfeeding at 6 and 12 months.
3. Women are meeting the Healthy People 2020 goals for breastfeeding initiation and breastfeeding at 6 months, but not for 12 months.
4. Women are meeting all the Healthy People 2020 goals for breastfeeding; therefore there is discussion of revising the goals to set a higher target.
5. Women in the south are not meeting any of the Healthy People 2020 breastfeeding objectives.

1. Which correctly describes the Healthy People 2020 breastfeeding goals?
2. 82% of mothers initiating breastfeeding, 61% of mothers breastfeeding at 6 months, and 34% of mothers breastfeeding at 12 months
3. 75% of mothers initiating breastfeeding, 50% of mothers breastfeeding at 6 months, and 25% of mothers breastfeeding at 12 months
4. 100% of mothers initiating breastfeeding, 55% of mothers breastfeeding at 6 months, and 22% of mothers breastfeeding at 12 months
5. None of the above

1. Shelly is a 25-year-old breastfeeding mom who is trying to lose weight. Her OBGYN has suggested that she go on a very-low-fat diet (~15% of calories) to help with weight loss. How will this change the fat composition of her breast milk?
2. It will not change the fat composition at all.
3. Her breast milk will contain more very-long-chain fatty acids.
4. Her breast milk will contain more saturated fatty acids.
5. Her breast milk will contain more medium-chain fatty acids.
6. Her breast milk will contain more cholesterol.

Use the following information for questions 35-37:

A young woman comes into your office for a lactation consultation complaining that her 1-month-old baby is colicky and slow to gain weight. Her baby requires 6 to 7 diaper changes each day and suffers from diarrhea. She tells you she allows the baby to nurse equally on each breast so that she does not feel “overfull”; she is desperate for help and asks your advice on what to do. A 24-hour diet history provides the following information about her eating habits.

Breakfast: cereal, milk, banana, and walnut pieces; sometimes she has eggs

Lunch: peanut butter sandwich, salad, and grapes with a glass of milk

Dinner: fish or chicken, vegetables, potato or rice, applesauce, and milk

Snacks: change daily, but she likes trail mix because it is easy to eat when nursing

1. What would the best advice be for this woman?
2. Allow your baby to nurse on one breast only until it is completely empty.
3. Allow us to evaluate you while you are nursing your baby and see what you are doing.
4. Stop nursing immediately and use an infant formula so your baby starts growing.
5. Use supplemental infant formula after each feeding because the baby is obviously not getting enough to eat.
6. a and b only

1. What is likely happening to this baby and causing the diarrhea?
2. The baby is not latched on properly.
3. The mother is not producing enough breast milk.
4. The baby is getting too much foremilk and not enough hindmilk.
5. The baby has a poor suckle.
6. The baby is lactose intolerant.

1. After looking at her diet, what changes could you suggest to help with the baby’s colic?
2. Eliminate all fruit except canned fruit
3. Eliminate nuts
4. Eliminate dairy products
5. All of the above
6. b and c only

1. A nursing mother is given a diaper bag full of formula samples and coupons by her nurse upon discharge from the hospital. What is the nurse telling her?
2. She has been a great patient and her nurse wants to give her a gift.
3. The nurse wants to make sure she can get a discount on formula should she decide to try it instead of breastfeed.
4. The nurse knows she is returning to work and will need to supplement the baby’s diet.
5. The nurse is letting her know that formula is just as good as breast milk.
6. Both b and c

1. Is it normal for colostrum to be green?
2. Yes; colostrum is the first milk and is always green.
3. No; this definitely sounds wrong; you should talk to you doctor about it.
4. The green color will clear up if you continue to nurse.

1. Continuing to nurse while you are sick actually protects your baby because:
2. you do not pass germs through breast milk.
3. your breast milk is full of antibodies that are passed on to your baby.
4. you do not contaminate bottles by handling them.
5. infant formulas are higher in vitamins and minerals and help boost the baby’s immune system.

1. A baby that is not given vitamin K at birth may have:
2. excessive bleeding due to a lack of blood clotting.
3. decreased calcium absorption.
4. increased incidence of colic.
5. increased incidence of diarrhea.
6. All of the above

1. What would be the best response to a new mother who asks you: “My baby is two months old and I just started working again part time; I pump once at work every day, and get between two and three ounces. Is this enough?”
2. It depends on how much your baby drinks.
3. You will need to pump or nurse every 2-3 hours to maintain your supply.
4. It is imperative that you are consistent with pumping and feeding.
5. All of the above

True/False

1. One of the key messages of the WIC Best Start campaign is the involvement of family and friends to make breastfeeding a success.

1. When breastfeeding, you should hear a smacking or clicking sound which indicates the baby is getting milk.

1. As of 2012 breastfeeding rates are continuing to rise.

1. Breastfeeding women on a vegetarian diet tend to get plenty of protein as long as their energy intakes are adequate.

1. Breastfeeding has been found to be just as effective as other methods of birth control, such as the birth control pill.

1. Breastfeeding may be used to reduce infant discomfort during minor invasive procedures.

1. In the early 1900s almost all infants in the U.S. were breastfed.

1. Letdown ONLY occurs when the infant suckles the breast.

1. The size of a woman’s breast limits her ability to STORE milk.

1. Infants appear to be interested in their mother’s milk when flavors are new to them.

Matching

1. Colostrum 2. Secretory immunoglobulin A 3. Prolactin 4. Oxytocin 5. Alveoli 6. Secretory cells 7. Myoepithelial cells 8. Lobes 9. Lactogenesis 10. Foremilk 11. Hindmilk

A. cells in the milk gland that are responsible for secreting milk components into the ducts B. rounded or oblong-shaped cavities in the breast C. rounded structures of the mammary gland D. milk at the end of feeding that contains a higher amount of human milk fat E. milk at the beginning of a feeding that contains a lower amount of human milk fat F. specialized cells that line the alveoli and contract to cause milk to be secreted into the duct G. one of the primary proteins present in colostrum H. hormone secreted by the pituitary that causes milk “let down” I. hormone secreted by the pituitary that stimulates milk production J. the thick, yellow fluid produced in the first 2-3 days after birth, high in protein K. another term for milk production

Short Answer

1. A congressman wants more information about the success of the Special Supplemental Nutrition Program called “WIC.” Identify four benefits of breastfeeding (maternal or infant) for the congressman. Also, identify one socioeconomic fact that would convince the congressman to support the program.

1. Identify three reflexes of healthy term infants. Discuss how these help infants obtain adequate nutrients from breastfeeding.

1. After her first baby was born, Sue Smith wanted to lose weight before she returned to work in 6 months. She sought nutrition care from a dietitian to set up an eating and exercise plan. Identify three questions that would initiate a discussion about weight loss postpartum.

1. A rural hospital received the Baby-Friendly Hospital Initiative packet and wanted to promote successful breastfeeding. The first goal was to educate all staff members on ways to communicate the benefits of breastfeeding. Identify at least four verbal and non-verbal examples that hospital staff could implement to establish a “breastfeeding friendly” environment.

1. If a friend of yours were to become a breastfeeding mom, would you be able to support her decision to breastfeed? Are there other people that would support her decision? What information would you want to give her? What place would provide the least supportive breastfeeding environment and why?

1. Discuss the stand that the American Academy of Pediatrics has taken on breastfeeding, saying that “breastfeeding should continue for a year or longer.” Does this stand differ from what the U.S. Surgeon General advocates? What research would back up either of these statements?

1. How does proper positioning of an infant aid in breastfeeding success? Describe techniques that might benefit a mother who is trying to properly position her infant. Explain how a first-time mom would get help with proper positioning.

1. What are some factors that would influence the initiation and/or duration of a new mother’s decision to breastfeed? How would you go about encouraging a woman to breastfeed after she has encountered several negative influences?

Test Bank[2] for Chapter 7 – Nutrition during Lactation:
Conditions and Interventions

Key to question information: ANS = correct answer; DIF = question difficulty; REF = page reference; OBJ = chapter learning objective for question section

Learning Objectives

7.1 List five common breastfeeding conditions.

7.2 Identify positive and negative impacts of maternal medications on mother’s breast milk.

7.3 Give two examples of herbal galactogogues.

7.4 Describe the impact of alcohol on mother’s milk.

7.5 Explain causes of hyperbilirubinemia and ways to prevent kernicterus.

7.6 List at least two ways health professionals can help the mother of multiples face the challenges of breastfeeding.

7.7 Explain the difference between food allergy and food intolerance.

7.8 Identify at least three factors that contribute to increased readmission rates for late-preterm infants.

7.9 List three benefits of mother’s breast milk for premature infants.

7.10 Demonstrate knowledge of medical contraindications to breastfeeding.

7.11 List 3 guidelines for storage of human milk for home use.

7.12 Review one of the model programs for breastfeeding promotion in the United States.

Multiple Choice

1. Which of the following would NOT be considered a common condition that is experienced by a woman who is breastfeeding?
2. Sore nipples
3. Engorgement
4. Mastitis
5. Plugged ducts
6. All of the above are common problems.

ANS: e DIF: Fact-based REF: 198-202 OBJ: 7.1

1. Medications contraindicated during breastfeeding include all of the following EXCEPT:
2. antineoplastic agents.
3. radioactive isotopes.
4. antihistamines.
5. drugs of abuse.
6. drugs that suppress lactation.

ANS: c DIF: Fact-based REF: 203 OBJ: 7.2

1. Which of the following would NOT be considered a simple step to manage nipple pain?
2. Air-drying breasts after nursing
3. Rubbing expressed milk or an all-purpose ointment on nipples
4. Using Vaseline to protect nipples
5. Using warm compresses

ANS: c DIF: Fact-based REF: 198 OBJ: 7.1

1. The most important step to prevent sore nipples is to _____.
2. take a prophylactic dose of antibiotics
3. make sure the baby is positioned properly
4. place cabbage leaves on your breasts before nursing
5. place herbal salve on the nipple area
6. nurse frequently

ANS: b DIF: Fact-based, easy REF: 198 OBJ: 7.1

1. A mom with a newborn called a nurse practitioner to report that one of her breasts was painful, enlarged, and had a red area. In order to distinguish between two common conditions, what additional information would the practitioner want?
2. Time of onset
3. Where is the pain?
4. Do you have a fever?
5. Any flu-like symptoms?
6. All of the above

ANS: e DIF: Application-based, easy REF: 200 OBJ: 7.1

1. For a woman experiencing let-down failure, good advice would include all of the following EXCEPT:
2. getting out of the house for a walk.
3. changing nursing positions.
4. playing soothing music.
5. increasing water consumption and decreasing caffeine.
6. All of the above are recommended techniques.

ANS: e DIF: Application-based REF: 199 OBJ: 7.1

1. The best way to prevent/cure a plugged duct is to:
2. use a needle to unblock the duct.
3. completely empty the breast.
4. stop nursing and use a breast pump exclusively.
5. take extra vitamin D.
6. have a glass of red wine daily.

ANS: b DIF: Application-based REF: 200 OBJ: 7.1

1. All of the following are recommended treatments for plugged ducts EXCEPT _____.
2. stop breastfeeding until you see a health care provider
3. gently massage the affected breast
4. apply warm compresses
5. change nursing positions
6. take one tablespoon per day of lecithin

ANS: a DIF: Fact-based, easy REF: 200 OBJ: 7.1

1. If a breastfeeding mother needs to use a specific medication, what should you tell her?
2. If the hazards are minimal, use the medication after nursing.
3. Try an oral inhalant vs. an oral medication.
4. Take the lowest effective dose of the medication for the shortest duration.
5. All of the above

ANS: d DIF: Application-based REF: 204 OBJ: 7.2

1. Which drugs CANNOT be taken when breastfeeding?
2. Most oral contraceptives
3. Acetaminophen
4. Radioisotope drugs
5. Cold decongestants

ANS: c DIF: Fact-based, medium REF: 203-204 OBJ: 7.2

1. When is the safest time for a nursing mom to take a drug?
2. In the morning
3. After eating a meal
4. After the infant nurses
5. Any time is safe to take a drug.
6. It is never safe for a nursing mom to take drugs.

ANS: c DIF: Fact-based, medium REF: 204 OBJ: 7.2

1. It will take approximately _____ hour(s) to eliminate the alcohol in one glass of wine from a 120-pound nursing woman.
2. <1
3. 2 to 3
4. 4 to 5
5. 6 to 7
6. 12 or more

ANS: b DIF: Application-based, easy REF: 207 OBJ: 7.4

1. If a 110-lb nursing woman (50 kg) wants to drink alcohol, how many cans of beer (15 g alcohol/12 oz) can this woman drink and stay within the Institute of Medicine’s alcohol recommendations?
2. 0
3. 1
4. 2
5. 3

ANS: b DIF: Application-based, hard REF: 208 OBJ: 7.4

1. A breastfeeding mother asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?
2. Yes; in fact, discarding your breast milk is a good thing to do if you would like to drink while breastfeeding.
3. Yes; pumping will help, but you need to pump for the next 24 hours and discard any milk that you collect.
4. No; your breast milk will still contain alcohol; you will need to wait 1 hour per alcoholic beverage and then pump the milk and discard it to be safe.
5. No; the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream: roughly 2 to 3 hours per drink for a 120-pound woman.
6. None of the above will help eliminate alcohol from breast milk.

ANS: d DIF: Application-based REF: 207 OBJ: 7.4

1. The recommendation for use of herbal teas in nursing women is:
2. choose teas using herbs for essence.
3. choose natural teas.
4. choose synthetic teas.
5. choose teas that have traditional uses dating back thousands of years.
6. choose whatever tea is preferred; all tea is safe.

ANS: a DIF: Fact-based, medium REF: 205 OBJ: 7.3

1. Which of the following herbs is considered “safe” to use during lactation?
2. Echinacea
3. St. John’s wort
4. Fenugreek
5. Feverfew
6. Foxglove

ANS: c DIF: Fact-based REF: 202|204-205 OBJ: 7.1|7.3

1. Which of the following would NOT be a symptom of an infant suffering from an excess of caffeine?
2. Colic
3. Hyperactivity
4. Wakefulness
5. Diarrhea
6. Fussiness

ANS: d DIF: Fact-based REF: 210 OBJ: 7.4

1. Which of the following foods has been shown to cause colicky babies?
2. Red peppers
3. Chocolate
4. Garlic
5. Tomatoes

ANS: c DIF: Fact-based, easy REF: 217 OBJ: 7.7

1. Approximately _____ of term infants will become visibly jaundiced with their serum bilirubin levels exceeding 5 to 7 mg/dL.
2. 20%
3. 30%
4. 40%
5. 50%
6. 60%

ANS: c DIF: Fact-based REF: 211 OBJ: 7.5

1. Hyperbilirubinemia in newborns is caused by _____.
2. destruction of red blood cells
3. high blood lipid levels
4. high maternal intake of vitamin A
5. labor lasting over 12 hours

ANS: a DIF: Fact-based, medium REF: 212 OBJ: 7.5

1. Which of the following would be considered a minor risk factor for severe hyperbilirubinemia?
2. Maternal age <25 years
3. Normal-weight infant of diabetic mother
4. Gestational age >41 weeks
5. Formula feeding an infant
6. Male gender

ANS: e DIF: Fact-based REF: 212 OBJ: 7.5

1. Breast milk jaundice is believed to be caused by _____.
2. variability in the infant’s ability to process bilirubin
3. a component in the mother’s milk increasing bilirubin absorption
4. infrequent breastfeeding
5. All of the above

ANS: d DIF: Fact-based, medium REF: 215 OBJ: 7.5

1. The total bilirubin content of an infant’s meconium is _____.
2. <200 mg
3. 375 mg
4. 400 mg
5. 450 mg

ANS: d DIF: Fact-based, medium REF: 215 OBJ: 7.5

1. What nutrition interventions are recommended for management of early jaundice?
2. Early and frequent breastfeeding
3. IV water feedings
4. Increased formula feedings
5. Dextrose feedings as a supplement to nursing

ANS: a DIF: Fact-based, easy REF: 214 OBJ: 7.5

1. What is a possible reason that breastfeeding may prevent allergies?
2. Influence on gut microbial flora
3. Transfer of maternal immunity
4. Transfer of maternal fatty acids and IGA in breast milk
5. Low content of allergens
6. All of the above

ANS: e DIF: Fact-based REF: 217 OBJ: 7.7

1. Common pediatric allergens include all of the following EXCEPT:
2. cow’s milk.
3. eggs.
4. peanuts.
5. soybeans
6. oats.

ANS: e DIF: Fact-based REF: 217 OBJ: 7.7

1. Which of the following is considered a benefit of breastfeeding a preterm infant?
2. Ease of protein digestion
3. Ease of fat absorption
4. Improved lactose digestion
5. Better visual acuity
6. All of the above

ANS: e DIF: Fact-based REF: 219 OBJ: 7.9

1. Factors contributing to the rate of transmission of HIV from the mother to an infant while breastfeeding include all of the following EXCEPT:
2. strain of HIV.
3. immune status of mother.
4. viral load.
5. maternal illness.
6. All of the above are factors.

ANS: e DIF: Fact-based REF: 221 OBJ: 7.10

1. How many hours can freshly expressed breast milk be left at room temperature and still be considered safe for a baby?
2. 1-3 hr @ 78°F
3. 2-4 hr @ 78°F
4. 3-5 hr @ 78°F
5. 4-6 hr @ 78°F
6. 6-8 hr @ 78°F

ANS: e DIF: Fact-based, medium REF: 222 OBJ: 7.11

1. If nursing mothers want to store expressed milk in a refrigerator, what should the temperature setting be?
2. <50 degrees F
3. <39 degrees F
4. >40 degrees F
5. 78 degrees F

ANS: b DIF: Fact-based, medium REF: 222 OBJ: 7.11

1. The purpose of a human milk bank is to:
2. provide a place to donate milk for women whose supply exceeds the demands of their infants.
3. provide human milk to infants who cannot be breastfed by their mothers.
4. allow women to “keep their figure” by using a pump instead of allowing the child to nurse.
5. All of the above
6. a and b only

ANS: e DIF: Fact-based REF: 222 OBJ: 7.11

1. The scarcity of human milk banks in North America results from all of the following EXCEPT:
2. the availability of wet nurses.
3. a resurgence of tuberculosis.
4. HIV.
5. risks related to donors who might use drugs.

ANS: a DIF: Fact-based, easy REF: 222 OBJ: 7.11

1. Milk banks store donated milk in plastic containers because it _____.
2. expedites shipping
3. is less costly than glass
4. keeps white blood cells found in breast milk intact
5. is easier to express milk into plastic containers

ANS: c DIF: Fact-based, easy REF: 222-223 OBJ: 7.11

1. The energy content of breast milk in women who deliver pre-term infants is _____.
2. 30-37 kcal/100 mL
3. 40-48 kcal/100 mL
4. 58-70 kcal/100 mL
5. 72-120 kcal/100 mL

ANS: c DIF: Fact-based, medium REF: 219 OBJ: 7.9

1. Once growth is established in preterm infants, the infants’ nutritional needs exceed the content of human milk for which of the following nutrients?
2. Phosphorus
3. Calcium
4. Vitamin D
5. Vitamin C
6. All of the above

ANS: e DIF: Fact-based, medium REF: 219 OBJ: 7.9

1. A new mother goes to the mall shopping with her friends. She is gone longer than planned and is not able to nurse her baby until she returns 6 hours later. What is the most likely problem she will have?
2. A breast infection
3. Engorgement
4. Plugged ducts
5. Sore nipples
6. Mastitis

ANS: b DIF: Application-based REF: 199 OBJ: 7.1

1. What advice would be helpful for a first-time mom who would like to know how to prevent a decrease in milk production?
2. Relax and avoid stress.
3. Breastfeed or pump frequently.
4. Completely empty your breasts at each feeding, either by nursing or pumping.
5. All of the above
6. a and c only

ANS: d DIF: Application-based REF: 200|202 OBJ: 7.1

1. A lactation consultant is observing a new mom breastfeeding and notices that the baby is making smacking and clicking sounds as she sucks. This tells her that:
2. the baby is eating well and has a strong suckle.
3. the baby has a cleft palate and should be closely followed.
4. the baby is not latched on correctly and this may increase the risk of sore nipples.
5. this is just a noisy baby.
6. Noise is not an indicator of anything.

ANS: c DIF: Application-based REF: 198 OBJ: 7.1

1. Large doses of St. John’s wort decrease prolactin levels in women. This could potentially:
2. reduce oxytocin levels.
3. cause breast milk to taste like maple syrup.
4. cause a woman to become constipated.
5. reduce breast milk supply.
6. cause depression in some women.

ANS: d DIF: Fact-based REF: 206 OBJ: 7.3

1. Your best friend had a baby 3 months ago and is anxious to go “out on the town” with her friends. She is still breastfeeding, but would like to be able to have some drinks. What advice would you give her?
2. It is okay to drink while nursing because it actually helps babies sleep.
3. It is okay to drink while nursing because it increases breast milk production.
4. Pump your milk immediately after drinking and it will be eliminated from your body.
5. Pump milk before going out and use that until the alcohol has been cleared from your system.
6. Drink only beer because babies tolerate it.

ANS: d DIF: Application-based REF: 207|208 OBJ: 7.4

1. Delayed breastfeeding can lead to jaundice because
2. it produces a state of partial starvation.
3. it can lead to decreased passage of meconium.
4. it causes an increase in bilirubin concentration.
5. All of the above

ANS: d DIF: Fact-based REF: 214 OBJ: 7.5

1. How could the situation in question #41 be resolved?
2. Make sure mother and baby were nursing correctly and for an adequate length of time.
3. Check the mother’s milk supply to make sure she is producing enough milk to feed her baby.
4. Monitor infants for stooling.
5. Initiate breastfeeding early.
6. All of the above

ANS: e DIF: Application-based REF: 214 OBJ: 7.5

1. You are at a nice restaurant and would like to order seafood for dinner; however, you are breastfeeding. Which of the following would have the lowest amount of mercury and be safest for you to eat?
2. Calamari
3. Swordfish
4. Shark
5. Tuna
6. King mackerel

ANS: a DIF: Application-based REF: 211 OBJ: 7.4

1. A friend of yours has just given birth to twins and is planning to return to work full time when they are 3 months old. She has a nanny and feels confident that she will be able to breastfeed as well as work 50 hours per week. Which of the following will present a major challenge with this plan?
2. Fatigue and sleep deprivation
3. Lack of time to nurse or pump
4. Milk production capacity
5. All of the above
6. a and b only

ANS: e DIF: Application-based REF: 216 OBJ: 7.6

1. Which of the following foods would a pediatrician recommend a nursing mother with no history of food allergies in the family restrict?
2. Peanuts and tree nuts
3. Wheat
4. Soy
5. Eggs
6. None of the above

ANS: e DIF: Application-based REF: 217 OBJ: 7.7

1. What would be the best thing to do if you suspected your breastfed baby was responding adversely to milk in your diet?
2. Switch to a lactose-free formula and see if the symptoms go away.
3. Eliminate milk from your diet and monitor the baby for changes.
4. Eliminate strong-flavored vegetables, onions, and garlic from your diet because they can cause the same problems in babies.
5. All of the above would be good things to do.
6. a and c only

ANS: b DIF: Application-based REF: 217 OBJ: 7.7

True/False

1. Physicians typically are well trained to counsel women on breastfeeding.

ANS: F DIF: Fact-based, easy REF: 223 OBJ: 7.12

1. The vast majority of women experience SIGNIFICANT problems with breastfeeding.

ANS: F DIF: Fact-based REF: 198 OBJ: 7.1

1. A woman with mastitis should continue to nurse her baby.

ANS: T DIF: Fact-based, easy REF: 200 OBJ: 7.1

1. It is necessary to STOP nursing with mastitis.

ANS: F DIF: Fact-based REF: 200 OBJ: 7.1

1. Women should discontinue ALL medications while breastfeeding.

ANS: F DIF: Application-based, hard REF: 202 OBJ: 7.2

1. For women with a family history of peanut allergy, exclusive breastfeeding is recommended for 4 months.

ANS: T DIF: Application-based, easy REF: 216-217 OBJ: 7.7

1. A nursing mom should avoid cauliflower because it has the potential to cause gas in her baby.

ANS: F DIF: Application-based, easy REF: 217 OBJ: 7.7

1. Medicinal herbs have been shown to be a safe alternative to drugs during lactation.

ANS: F DIF: Fact-based REF: 205 OBJ: 7.3

1. Drinking one cup of coffee results in hyperactivity in all infants.

ANS: F DIF: Fact-based, medium REF: 210 OBJ: 7.4

1. Alcohol is not transferred through breast milk.

ANS: F DIF: Fact-based REF: 207 OBJ: 7.4

1. Alcohol has been found to be a “galactologue” that facilitates milk let-down and helps aid milk insufficiency.

ANS: F DIF: Fact-based REF: 207 OBJ: 7.4

1. It is better to smoke and breastfeed than to smoke and NOT breastfeed.

ANS: T DIF: Application-based REF: 209 OBJ: 7.4

1. Neonatal jaundice is a life-threatening condition that requires immediate medical intervention.

ANS: F DIF: Fact-based REF: 211 OBJ: 7.5

Matching

1. Mastitis 2. Engorgement 3. Plugged ducts 4. Letdown failure 5. Hyperactive letdown 6. Fenugreek 7. Echinacea 8. Hyperbilirubinemia 9. Cabbage leaves 10. Sore nipples

A. Mild discomfort after nursing B. Inflammation of the breast C. May act as galactogogue D. Used to enhance immune system E. Elevated levels of bilirubin F. Blockage of milk, which may be caused by milk stasis G. May help reduce discomfort and swelling in breasts H. Milk is not ejected from breasts I. Breast milk streams too quickly from breast at the onset of feeding J. When the breasts become overfilled

Key:

1. ANS: B DIF: Fact-based REF: 200 OBJ: 7.1
2. ANS: J DIF: Fact-based REF: 199 OBJ: 7.1
3. ANS: F DIF: Fact-based REF: 199 OBJ: 7.1
4. ANS: H DIF: Fact-based REF: 198 OBJ: 7.1
5. ANS: I DIF: Fact-based REF: 199 OBJ: 7.1
6. ANS: C DIF: Fact-based REF: 202 OBJ: 7.1
7. ANS: D DIF: Fact-based REF: 206 OBJ: 7.3
8. ANS: E DIF: Fact-based REF: 211 OBJ: 7.5
9. ANS: G DIF: Fact-based REF: 199 OBJ: 7.1
10. ANS: A DIF: Fact-based REF: 198 OBJ: 7.1

Short Answer

1. A nursing mom of a 2-week-old infant seeks health advice regarding the use of echinacea to ward off any colds brought home by her two school-aged children. Discuss the two key questions you should ask to analyze whether echinacea is safe. Also, name three other factors that must be considered.

ANS: See pp. 204-206.

DIF: Application-based, medium REF: 204-206 OBJ: 7.3

1. A breastfeeding mom called her health care provider after a neighbor told her that eating eggs could cause an infant to develop egg allergies. Discuss two possible reasons why breastfeeding prevents food allergies and identify two conditions demonstrating how breastfeeding influences food allergies.

ANS: See pp. 216-217.

DIF: Application-based, medium REF: 216-217 OBJ: 7.7

1. A social marketing program targeting physicians has shown that accurate, appropriate counseling and encouragement by physicians can improve initiation and duration of breastfeeding rates. Give two examples of ways physicians can offer encouragement and accurate counseling to a single mom wanting to breastfeed but also wanting to continue smoking cigarettes.

ANS: See p. 209.

DIF: Application-based, hard REF: 209 OBJ: 7.4

1. The following statement was made in the chapter: “Any decision to limit a mother’s breastfeeding must be justified by the fact that the risk to her baby clearly outweighs the benefits of breastfeeding.” Name two risks in a baby that would motivate you to stop breastfeeding. What are two minimal risks that would NOT motivate you to stop breastfeeding?

ANS: See pp. 200-204, 220-221.

DIF: Application-based, medium REF: 200-204|220-221
OBJ: 7.1|7.2|7.10

1. If a nursing mom was started on a new medication, what signs or symptoms would she look for to determine whether it was affecting her baby?

ANS: See pp. 202-204.

DIF: Application-based, medium REF: 202-204 OBJ: 7.2

1. Explain a) the importance of breastfeeding for premature infants, and b) how the composition of breast milk compares to that of the mother of a full-term infant. Are there any health concerns related to breastfeeding a preterm infant? Discuss.

ANS: See pp. 218-220.

DIF: Fact-based REF: 218-220 OBJ: 7.8|7.9

1. “Anyone can be a milk bank donor.” Is this statement true? Describe a milk bank and how they go about selecting women to provide milk.

ANS: See pp. 221-223.

DIF: Application-based REF: 221-223 OBJ: 7.11

1. Your best friend has just started to breastfeed her twin sons and has developed a reddish hard spot on her left breast. a) What is happening to her? b) Is it necessary that she stop breastfeeding? Explain why or why not, and then outline a plan for her in order to decrease the pain and allow her to continue breastfeeding. c) When would it become imperative that she stop breastfeeding?

ANS: See pp. 199-200.

DIF: Application-based REF: 199-200 OBJ: 7.1

Ready-to-Use Chapter 7 Test

Multiple Choice

1. Which of the following would NOT be considered a common condition that is experienced by a woman who is breastfeeding?
2. Sore nipples
3. Engorgement
4. Mastitis
5. Plugged ducts
6. All of the above are common problems.

1. Medications contraindicated during breastfeeding include all of the following EXCEPT:
2. antineoplastic agents.
3. radioactive isotopes.
4. antihistamines.
5. drugs of abuse.
6. drugs that suppress lactation.

1. Which of the following would NOT be considered a simple step to manage nipple pain?
2. Air-drying breasts after nursing
3. Rubbing expressed milk or an all-purpose ointment on nipples
4. Using Vaseline to protect nipples
5. Using warm compresses

1. The most important step to prevent sore nipples is to _____.
2. take a prophylactic dose of antibiotics
3. make sure the baby is positioned properly
4. place cabbage leaves on your breasts before nursing
5. place herbal salve on the nipple area
6. nurse frequently

1. A mom with a newborn called a nurse practitioner to report that one of her breasts was painful, enlarged, and had a red area. In order to distinguish between two common conditions, what additional information would the practitioner want?
2. Time of onset
3. Where is the pain?
4. Do you have a fever?
5. Any flu-like symptoms?
6. All of the above

1. For a woman experiencing let-down failure, good advice would include all of the following EXCEPT:
2. getting out of the house for a walk.
3. changing nursing positions.
4. playing soothing music.
5. increasing water consumption and decreasing caffeine.
6. All of the above are recommended techniques.

1. The best way to prevent/cure a plugged duct is to:
2. use a needle to unblock the duct.
3. completely empty the breast.
4. stop nursing and use a breast pump exclusively.
5. take extra vitamin D.
6. have a glass of red wine daily.

1. All of the following are recommended treatments for plugged ducts EXCEPT _____.
2. stop breastfeeding until you see a health care provider
3. gently massage the affected breast
4. apply warm compresses
5. change nursing positions
6. take one tablespoon per day of lecithin

1. If a breastfeeding mother needs to use a specific medication, what should you tell her?
2. If the hazards are minimal, use the medication after nursing.
3. Try an oral inhalant vs. an oral medication.
4. Take the lowest effective dose of the medication for the shortest duration.
5. All of the above

1. Which drugs CANNOT be taken when breastfeeding?
2. Most oral contraceptives
3. Acetaminophen
4. Radioisotope drugs
5. Cold decongestants

1. When is the safest time for a nursing mom to take a drug?
2. In the morning
3. After eating a meal
4. After the infant nurses
5. Any time is safe to take a drug.
6. It is never safe for a nursing mom to take drugs.

1. It will take approximately _____ hour(s) to eliminate the alcohol in one glass of wine from a 120-pound nursing woman.
2. <1
3. 2 to 3
4. 4 to 5
5. 6 to 7
6. 12 or more

1. If a 110-lb nursing woman (50 kg) wants to drink alcohol, how many cans of beer (15 g alcohol/12 oz) can this woman drink and stay within the Institute of Medicine’s alcohol recommendations?
2. 0
3. 1
4. 2
5. 3

1. A breastfeeding mother asks you if alcohol can be eliminated from her breast milk by pumping immediately after drinking a few glasses of wine. What would you tell her?
2. Yes; in fact, discarding your breast milk is a good thing to do if you would like to drink while breastfeeding.
3. Yes; pumping will help, but you need to pump for the next 24 hours and discard any milk that you collect.
4. No; your breast milk will still contain alcohol; you will need to wait 1 hour per alcoholic beverage and then pump the milk and discard it to be safe.
5. No; the alcohol will still be in the breast milk and will clear from the milk as soon as it clears from the blood stream: roughly 2 to 3 hours per drink for a 120-pound woman.
6. None of the above will help eliminate alcohol from breast milk.

1. The recommendation for use of herbal teas in nursing women is:
2. choose teas using herbs for essence.
3. choose natural teas.
4. choose synthetic teas.
5. choose teas that have traditional uses dating back thousands of years.
6. choose whatever tea is preferred; all tea is safe.

1. Which of the following herbs is considered “safe” to use during lactation?
2. Echinacea
3. St. John’s wort
4. Fenugreek
5. Feverfew
6. Foxglove

1. Which of the following would NOT be a symptom of an infant suffering from an excess of caffeine?
2. Colic
3. Hyperactivity
4. Wakefulness
5. Diarrhea
6. Fussiness

1. Which of the following foods has been shown to cause colicky babies?
2. Red peppers
3. Chocolate
4. Garlic
5. Tomatoes

1. Approximately _____ of term infants will become visibly jaundiced with their serum bilirubin levels exceeding 5 to 7 mg/dL.
2. 20%
3. 30%
4. 40%
5. 50%
6. 60%

1. Hyperbilirubinemia in newborns is caused by _____.
2. destruction of red blood cells
3. high blood lipid levels
4. high maternal intake of vitamin A
5. labor lasting over 12 hours

1. Which of the following would be considered a minor risk factor for severe hyperbilirubinemia?
2. Maternal age <25 years
3. Normal-weight infant of diabetic mother
4. Gestational age >41 weeks
5. Formula feeding an infant
6. Male gender

1. Breast milk jaundice is believed to be caused by _____.
2. variability in the infant’s ability to process bilirubin
3. a component in the mother’s milk increasing bilirubin absorption
4. infrequent breastfeeding
5. All of the above

1. The total bilirubin content of an infant’s meconium is _____.
2. <200 mg
3. 375 mg
4. 400 mg
5. 450 mg

1. What nutrition interventions are recommended for management of early jaundice?
2. Early and frequent breastfeeding
3. IV water feedings
4. Increased formula feedings
5. Dextrose feedings as a supplement to nursing

1. What is a possible reason that breastfeeding may prevent allergies?
2. Influence on gut microbial flora
3. Transfer of maternal immunity
4. Transfer of maternal fatty acids and IGA in breast milk
5. Low content of allergens
6. All of the above

1. Common pediatric allergens include all of the following EXCEPT:
2. cow’s milk.
3. eggs.
4. peanuts.
5. soybeans
6. oats.

1. Which of the following is considered a benefit of breastfeeding a preterm infant?
2. Ease of protein digestion
3. Ease of fat absorption
4. Improved lactose digestion
5. Better visual acuity
6. All of the above

1. Factors contributing to the rate of transmission of HIV from the mother to an infant while breastfeeding include all of the following EXCEPT:
2. strain of HIV.
3. immune status of mother.
4. viral load.
5. maternal illness.
6. All of the above are factors.

1. How many hours can freshly expressed breast milk be left at room temperature and still be considered safe for a baby?
2. 1-3 hr @ 78°F
3. 2-4 hr @ 78°F
4. 3-5 hr @ 78°F
5. 4-6 hr @ 78°F
6. 6-8 hr @ 78°F

1. If nursing mothers want to store expressed milk in a refrigerator, what should the temperature setting be?
2. <50 degrees F
3. <39 degrees F
4. >40 degrees F
5. 78 degrees F

1. The purpose of a human milk bank is to:
2. provide a place to donate milk for women whose supply exceeds the demands of their infants.
3. provide human milk to infants who cannot be breastfed by their mothers.
4. allow women to “keep their figure” by using a pump instead of allowing the child to nurse.
5. All of the above
6. a and b only

1. The scarcity of human milk banks in North America results from all of the following EXCEPT:
2. the availability of wet nurses.
3. a resurgence of tuberculosis.
4. HIV.
5. risks related to donors who might use drugs.

1. Milk banks store donated milk in plastic containers because it _____.
2. expedites shipping
3. is less costly than glass
4. keeps white blood cells found in breast milk intact
5. is easier to express milk into plastic containers

1. The energy content of breast milk in women who deliver pre-term infants is _____.
2. 30-37 kcal/100 mL
3. 40-48 kcal/100 mL
4. 58-70 kcal/100 mL
5. 72-120 kcal/100 mL

1. Once growth is established in preterm infants, the infants’ nutritional needs exceed the content of human milk for which of the following nutrients?
2. Phosphorus
3. Calcium
4. Vitamin D
5. Vitamin C
6. All of the above

1. A new mother goes to the mall shopping with her friends. She is gone longer than planned and is not able to nurse her baby until she returns 6 hours later. What is the most likely problem she will have?
2. A breast infection
3. Engorgement
4. Plugged ducts
5. Sore nipples
6. Mastitis

1. What advice would be helpful for a first-time mom who would like to know how to prevent a decrease in milk production?
2. Relax and avoid stress.
3. Breastfeed or pump frequently.
4. Completely empty your breasts at each feeding, either by nursing or pumping.
5. All of the above
6. a and c only

1. A lactation consultant is observing a new mom breastfeeding and notices that the baby is making smacking and clicking sounds as she sucks. This tells her that:
2. the baby is eating well and has a strong suckle.
3. the baby has a cleft palate and should be closely followed.
4. the baby is not latched on correctly and this may increase the risk of sore nipples.
5. this is just a noisy baby.
6. Noise is not an indicator of anything.

1. Large doses of St. John’s wort decrease prolactin levels in women. This could potentially:
2. reduce oxytocin levels.
3. cause breast milk to taste like maple syrup.
4. cause a woman to become constipated.
5. reduce breast milk supply.
6. cause depression in some women.

1. Your best friend had a baby 3 months ago and is anxious to go “out on the town” with her friends. She is still breastfeeding, but would like to be able to have some drinks. What advice would you give her?
2. It is okay to drink while nursing because it actually helps babies sleep.
3. It is okay to drink while nursing because it increases breast milk production.
4. Pump your milk immediately after drinking and it will be eliminated from your body.
5. Pump milk before going out and use that until the alcohol has been cleared from your system.
6. Drink only beer because babies tolerate it.

1. Delayed breastfeeding can lead to jaundice because
2. it produces a state of partial starvation.
3. it can lead to decreased passage of meconium.
4. it causes an increase in bilirubin concentration.
5. All of the above

1. How could the situation in question #41 be resolved?
2. Make sure mother and baby were nursing correctly and for an adequate length of time.
3. Check the mother’s milk supply to make sure she is producing enough milk to feed her baby.
4. Monitor infants for stooling.
5. Initiate breastfeeding early.
6. All of the above

1. You are at a nice restaurant and would like to order seafood for dinner; however, you are breastfeeding. Which of the following would have the lowest amount of mercury and be safest for you to eat?
2. Calamari
3. Swordfish
4. Shark
5. Tuna
6. King mackerel

1. A friend of yours has just given birth to twins and is planning to return to work full time when they are 3 months old. She has a nanny and feels confident that she will be able to breastfeed as well as work 50 hours per week. Which of the following will present a major challenge with this plan?
2. Fatigue and sleep deprivation
3. Lack of time to nurse or pump
4. Milk production capacity
5. All of the above
6. a and b only

1. Which of the following foods would a pediatrician recommend a nursing mother with no history of food allergies in the family restrict?
2. Peanuts and tree nuts
3. Wheat
4. Soy
5. Eggs
6. None of the above

1. What would be the best thing to do if you suspected your breastfed baby was responding adversely to milk in your diet?
2. Switch to a lactose-free formula and see if the symptoms go away.
3. Eliminate milk from your diet and monitor the baby for changes.
4. Eliminate strong-flavored vegetables, onions, and garlic from your diet because they can cause the same problems in babies.
5. All of the above would be good things to do.
6. a and c only

True/False

1. Physicians typically are well trained to counsel women on breastfeeding.

1. The vast majority of women experience SIGNIFICANT problems with breastfeeding.

1. A woman with mastitis should continue to nurse her baby.

1. It is necessary to STOP nursing with mastitis.

1. Women should discontinue ALL medications while breastfeeding.

1. For women with a family history of peanut allergy, exclusive breastfeeding is recommended for 4 months.

1. A nursing mom should avoid cauliflower because it has the potential to cause gas in her baby.

1. Medicinal herbs have been shown to be a safe alternative to drugs during lactation.

1. Drinking one cup of coffee results in hyperactivity in all infants.

1. Alcohol is not transferred through breast milk.

1. Alcohol has been found to be a “galactologue” that facilitates milk let-down and helps aid milk insufficiency.

1. It is better to smoke and breastfeed than to smoke and NOT breastfeed.

1. Neonatal jaundice is a life-threatening condition that requires immediate medical intervention.

Matching

1. Mastitis 2. Engorgement 3. Plugged ducts 4. Letdown failure 5. Hyperactive letdown 6. Fenugreek 7. Echinacea 8. Hyperbilirubinemia 9. Cabbage leaves 10. Sore nipples

A. Mild discomfort after nursing B. Inflammation of the breast C. May act as galactogogue D. Used to enhance immune system E. Elevated levels of bilirubin F. Blockage of milk, which may be caused by milk stasis G. May help reduce discomfort and swelling in breasts H. Milk is not ejected from breasts I. Breast milk streams too quickly from breast at the onset of feeding J. When the breasts become overfilled

Short Answer

1. A nursing mom of a 2-week-old infant seeks health advice regarding the use of echinacea to ward off any colds brought home by her two school-aged children. Discuss the two key questions you should ask to analyze whether echinacea is safe. Also, name three other factors that must be considered.

1. A breastfeeding mom called her health care provider after a neighbor told her that eating eggs could cause an infant to develop egg allergies. Discuss two possible reasons why breastfeeding prevents food allergies and identify two conditions demonstrating how breastfeeding influences food allergies.

1. A social marketing program targeting physicians has shown that accurate, appropriate counseling and encouragement by physicians can improve initiation and duration of breastfeeding rates. Give two examples of ways physicians can offer encouragement and accurate counseling to a single mom wanting to breastfeed but also wanting to continue smoking cigarettes.

1. The following statement was made in the chapter: “Any decision to limit a mother’s breastfeeding must be justified by the fact that the risk to her baby clearly outweighs the benefits of breastfeeding.” Name two risks in a baby that would motivate you to stop breastfeeding. What are two minimal risks that would NOT motivate you to stop breastfeeding?

1. If a nursing mom was started on a new medication, what signs or symptoms would she look for to determine whether it was affecting her baby?

1. Explain a) the importance of breastfeeding for premature infants, and b) how the composition of breast milk compares to that of the mother of a full-term infant. Are there any health concerns related to breastfeeding a preterm infant? Discuss.

1. “Anyone can be a milk bank donor.” Is this statement true? Describe a milk bank and how they go about selecting women to provide milk.

1. Your best friend has just started to breastfeed her twin sons and has developed a reddish hard spot on her left breast. a) What is happening to her? b) Is it necessary that she stop breastfeeding? Explain why or why not, and then outline a plan for her in order to decrease the pain and allow her to continue breastfeeding. c) When would it become imperative that she stop breastfeeding?

[1] by Susan Gollnick of California Polytechnic State University and Tawni Holmes of University of Central Oklahoma; see the end of this document for a ready-to-use version of this test (without answers) for easy printing or cutting/pasting

[2] by Susan Gollnick of California Polytechnic State University and Tawni Holmes of University of Central Oklahoma; see the end of this document for a ready-to-use version of this test (without answers) for easy printing or cutting/pasting