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ALPP CLC EXAM 2025 CERTIFIED LACTATION COUNSELOR
REAL/AUTHENTIC PROCTORED EXAM
QUESTIONS AND VERIFIED ANSWERS
ābreast feeding: a public health priority - CORRECT ANSWER has been recognized as a public
health priority in tropical climates since the 1930's, but not until the 1990's in the US"
"the code - CORRECT ANSWER regulates the marketing of breastmilk substitutes which
includes infant formulas, follow-on formulas, and any other food or drink, together with feeding bottles and teats, intended for babies and young children; sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries"
"restricting marketing - CORRECT ANSWER does not mean that the products cannot be
made available, neither does it restrict parents choice; it simply aims to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims"
"the strategy - CORRECT ANSWER is intended as a guide for action
- it identifies interventions with a proven positive impact
- it emphasizes providing mothers and families the support they need to carry out their crucial roles
- it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties"
"the world breastfeeding trends initiative - CORRECT ANSWER intended to track, assess, and
monitor the implementation of the "global strategy" at the country and sub-country level"
"what contributes to low rates of ebf globally? - CORRECT ANSWER - caregiver and societal
beliefs favoring mixed feeding -hospital and healthcare practices and policies that are not supportive of BF
- lack of adequate skills and support
- aggressive promotion of infant formula and other breastmilk substitutes
- inadequate maternity/paternity leave legislation
- workplace policies
- lack of knowledge about dangers of not exclusively BF and proper BF techniques"
"how to support ebf - CORRECT ANSWER increase hospital and health system capacity
regarding baby friendly hospital initiative -provide community based strategies including campaigns tailored to local context -strengthen monitoring and enforcement of the code -enact at least 6 months paid maternity leave
-invest in training and capacity building in protection, promotion, support"
"disparity of US breastfeeding trends - CORRECT ANSWER according to the CDC, "black
mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents""
"anatomy of milk cells - CORRECT ANSWER myoepithelial cells, connective tissue,
capillaries, anteriole, venule, alveolar cells"
"anatomy of human breast - CORRECT ANSWER glandular tissue made up of clusters of
alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings"
"preterm milk - CORRECT ANSWER appears to have a different composition for the first 5-
weeks after delivery independent of gestational age at delivery
- appears to be higher in protein, fat, and electrolytes than term milk
- if baby is SGA, LGA, or AGA, does not make a difference in milk composition"
"after 1 year of lactation - CORRECT ANSWER has significantly increased fat and energy
contents"
"fore vs hind milk - CORRECT ANSWER foremilk is milk at the beginning of a feed, hindmilk
is at the end of a feed
- used to think that hindmilk contained more fat content but it is more complex than originally described
- foremilk does not mean "low fat" and hindmilk is not always highest in fat
- sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk"
"breastmilk composition changes - CORRECT ANSWER - over the course of lactation
- within the day
- within a feeding
- between feedings is also changes by the way it is taken"
"babyled feeding - CORRECT ANSWER "the breast-fed baby can regulate his fat intake
quickly and thus mothers should be encouraged to practice baby-led feeding""
"maximum fat levels - CORRECT ANSWER obtained 30 mins post-feed
"stress & hormones - CORRECT ANSWER stress + male hormones = fight or flight
stress + oxytocin + female hormones = tend and befriend"
"postpartum post traumatic stress disorder (PP-PTSD) - CORRECT ANSWER up to 9% of PP
women met the DSM-5 criteria for PTSD after childbirth"
"two conditions that increase odds of PP-PTSD - CORRECT ANSWER - depressive symptom
scores
- total number of physical symptoms experienced since birth"
"MYTH - its about the types or amounts of foods eaten during laction - CORRECT ANSWER
humans have breastfed and are breastfeeding under conditions we can't even imagine. this is possible because:
- lactation has a lower energy cost for humans compared to other mammals
- number of kcal/day for lactation is much less than previously believed
- the body adapts with physiological mechanisms in favor of lactation in humans"
"when the infant suckles from the breast... - CORRECT ANSWER there is an outpouring of 19
different GI hormones in both the mother and the infant, including cholecystokinin, which cycles to the kidneys, and gastrin, which stimulates growth of the baby and mother's villi, increasing surface area and absorption of calories with each feeding" "Cherie, a new mother, with a 4-week-old infant, visits you for a breastfeeding evaluation. In the process of taking her history, you find that Cherie eats mostly chips, cookies and soda "because she is just too busy to prepare anything". Your MOST IMPORTANT concern with Cherie's diet is: a) The quality of her breast milk b) The quantity of her breast milk c) The health of the baby
d) The depletion of Cherie's nutrient stores - CORRECT ANSWER d) The depletion of Cherie's
nutrient stores" "Halli is now 2-hours-old and still has not shown any interest in nursing. You do a blood sugar test on Halli, and find that it's 38 mg/dL, which is lower than your hospital standard of 40 mg/dL. What should you do first? a) Put her under the warmer as she is most likely hypothermic b) Give her 1 oz. of formula by finger-feeding c) Have mom hand express colostrum and feed her with a spoon
d) Wait about 30 seconds and use a second reagent strip to check the glucose - CORRECT
ANSWER d) Wait about 30 seconds and use a second reagent strip to check the glucose"
"Mothers with breastfeeding problems may be hesitant to seek help from a professional for the following reason: a) Lack of insurance coverage for lactation services b) Having to leave her home to seek help c) Stress of having to repeat "her story" to multiple people d) Having problems is in conflict with the image of being a super-mom, which she wants to
portray - CORRECT ANSWER d) Having problems is in conflict with the image of being a
super-mom, which she wants to portray" "A type of research that focuses on relationships among variables is called: a) Qualitative b) Quantitative c) Statistically significant
d) Randomized controlled trials - CORRECT ANSWER b) Quantitative"
"Nipple erection is induced by which of the following? a) Myoepithelial cells contracting the lactiferous sinuses b) Somatic parasympathetic stimuli c) Autonomic sympathetic stimuli
d) Adequate levels of aphrodisiacs - CORRECT ANSWER b) Somatic parasympathetic
stimuli" "Which of the following drug categories are contraindicated for use during breastfeeding? a) Pseudoephedrine b) Oral contraceptives c) Cancer chemotherapeutic agents
d) Diuretics - CORRECT ANSWER c) Cancer chemotherapeutic agents"
"You are a nurse who works at St. Beneficial Hospital. You have just delivered preterm twins. A formula representative offers you samples of a new formula, which provides specific nutrients for your low birth weight infants. In what way is this a violation of the International Code of the Marketing of Breast-Milk Substitutes (WHO Code)? a) This isn't a violation as the WHO Code provides for samples of specialized formulas for low birth weight babies b) The WHO Code states that no personal samples of formula may be given to health care workers c) As an employee of a not-for-profit hospital, you cannot accept gifts from formula companies d) This isn't a violation because you are unable to breastfeed your twins, so accepting formula
isn't an issue - CORRECT ANSWER b) The WHO Code states that no personal samples of
formula may be given to health care workers"
d) Infant's chest is in contact with the mother's body and head is midline - CORRECT
ANSWER b) The baby's head is turned to one side, and is very slightly extended"
"When a hospital who was working to become Baby Friendly eliminated pacifier use, what was the outcome? a) Supplemental formula increased from 18-28% b) Breastfeeding challenges decreased by a factor of 10 c) Exclusive breastfeeding rates increased from 68-79%
d) 15% of mothers were sneaking pacifiers into the facility - CORRECT ANSWER a)
Supplemental formula increased from 18-28%" "The optimal time interval between pregnancies for a mother is: a) 6-9 months b) 12-15 months c) 24-30 months
d) 36-59 months - CORRECT ANSWER d) 36-59 months"
"Rebecca tells you that Tanya, her 3-week-old breastfed infant, has colic. You know that the most common reason for "colic" is: a) Infant isn't being fed enough b) Mother is smoking more than 1/3 pack of cigarettes per day c) Mother has too much breast milk
d) A diet that is very high in dairy products - CORRECT ANSWER a) Infant isn't being fed
enough" "Stacey visits you stating her "milk hasn't come in yet". Her baby is 10-days-old and hasn't regained her birth weight. After taking a history, you discover that Stacey continues to have heavy bleeding that contains blood clots. What do you suspect is the reason for the low milk supply? a) Retained placental fragments causing a decrease in prolactin levels b) Retained placental fragments causing estrogen levels to remain high c) Retained placental fragments causing progesterone levels to remain high
d) Retained placental fragments causing a drop in the prolactin inhibitory factor (PIF) -
CORRECT ANSWER c) Retained placental fragments causing progesterone levels to remain
high"
"Which of the following statements about prolactin is true? - CORRECT ANSWER Prolactin
causes milk to be made"
"Which of the following mechanisms cause oxytocin to be released? - CORRECT ANSWER
Nipple stretching with appropriate latch-on"
"Lactogenesis III requires which of the following to succeed? - CORRECT ANSWER Frequent
milk removal and nipple stimulation"
"The fat of milk suckled by the baby is determined by: - CORRECT ANSWER The
speed/efficiency with which the baby removes milk" "Which of the following is the most effective at increasing a gastric and CCK and decreasing
somatostatin in the baby - CORRECT ANSWER Feeding with species-specific milk"
"Studies on childhood obesity demonstrates that: - CORRECT ANSWER There is an inverse
relationship between duration and obesity prevalence in a large population"
"When undernourished mothers were supplemented with extra in their diet, they: - CORRECT
ANSWER Responded to their infants more appropriately"
"Carbohydrates found only in mammal milk? - CORRECT ANSWER Lactose"
"Cholecystokinin (CCK) helps babies feel a sense of - CORRECT ANSWER Satiety"
"Not enough water, too much stress, don't exercise - CORRECT ANSWER Myths"
"Not necessarily lower infant content - CORRECT ANSWER Foremilk"
"Gland that secretes lactation hormones - CORRECT ANSWER Pituitary"
"A cluster of milk-making cells - CORRECT ANSWER Alveolus"
"Stage II, it begins with the delivery of the placenta - CORRECT ANSWER Lactogenesis"
"Newborn milk - CORRECT ANSWER Colostrum"
"Human milk is composed of almost 88% - CORRECT ANSWER Water"
"Hormone responsible for milk ejection - CORRECT ANSWER Oxytocin"
"Breast milk is low int his nutrient but it is almost all bioavailable - CORRECT ANSWER Iron"
"Nerves that innervate the breast - CORRECT ANSWER Thorastic"
"Muscles cells around the alveolus - CORRECT ANSWER Myoepithelial cells"
"Inter bout interval - CORRECT ANSWER Period when baby is not at breast"
"Receptor site - CORRECT ANSWER Cellular "lock" for a chemical "key""
"Baby hand massage - CORRECT ANSWER Oxytocin releasing mechanism"
"Hyperinsulinemia - CORRECT ANSWER Associated with obesity in formula-fed infants"
"Abscess - CORRECT ANSWER A pocket of debris (pus) within the body containing broken
down blood cells and antibodies. Typically follows an infection, and causes local swelling and inflammation"
"Adipocytes - CORRECT ANSWER Fat cells"
"Adrenaline - CORRECT ANSWER A corticosteroid hormone responsible for the "fight or
flight" response"
"AGA - CORRECT ANSWER Appropriate for gestational age"
"Albumin - CORRECT ANSWER A form of protein found in the body"
"Alveoli - CORRECT ANSWER Small glands in the breast that produce breast milk"
"Amenorrhea - CORRECT ANSWER Absence of menstrual cycle"
"Anemia - CORRECT ANSWER A condition in which the blood is deficient in red blood cells,
in hemoglobin, or in total volume"
"The FDA reports that - CORRECT ANSWER There is no consistent pattern of who does and
does not make formula safely"
"Which of the following does not reduce the storage capacity of the breast - CORRECT
ANSWER Amount of tea mom drinks"
"With Sheehan;s Syndrome - CORRECT ANSWER Pituitary function may be impaired
permanently"
"Wendy is a WIC nutritionist who teaches a three hour., comprehensive breastfeeding class.
Which groups of "knowers" may have the most difficulty with Wendy's class? - CORRECT
ANSWER Women in silence"
"One of the reasons why women in developed have higher breast cancer reates than women in
developing countries is because - CORRECT ANSWER They breastfeed for shorter durations"
"Dr. Gerd is a pediatric gastroenterologist who conducts research on reflux. His practice reflective
studies that show that: - CORRECT ANSWER Cow milk allergy is associated with about 50%
of cases of reflux"
"Formula contamination with organisms is - CORRECT ANSWER A greater problem with
power than liquid"
"Babies who are formula fed are more likely to have which of the following outcomes -
CORRECT ANSWER Higher rates of SIDS"
"What is the most effective storage in breastfeeding counseling - CORRECT ANSWER
Listening" "Susie is 2 days old and she is not living up to her name. What is one possible reason for her
incorrect/unsuccessful breastfeeding - CORRECT ANSWER A 2 hour delay in initiating
feeding"
"An optimal state for breastfeeding is when the baby is - CORRECT ANSWER REM sleep"
"One of the advantages of having babies room-in with their mother is that - CORRECT
ANSWER Mothers can feed when feeding cues are given"
"Helping a mother to learn about correctly latching the baby on involves - CORRECT
ANSWER Observing of pre-feeding and readiness behaviors"
"When latching the baby to the breast - CORRECT ANSWER Start with the baby's nose at the
level of the nipple"
"Which of the following is an advantage of being skin-to-skin. For the infant - CORRECT
ANSWER Babies cry less"
"Pregnant women choose formula because they - CORRECT ANSWER Feel more comfortable
with the idea of formula feeding"
"Bringing back a milk lactation - CORRECT ANSWER Relactation"
"Metabolic disorder of the baby which makes breast milk contraindicated - CORRECT
ANSWER Galactosemia"
"Itchy flaky reddened breast and nipple may be - CORRECT ANSWER Candida"
"Pimple like block of a nipple sore - CORRECT ANSWER Bleb"
"Only contractecptives are ok for breastfeeding after 6 weeks - CORRECT ANSWER
Progesterone"
"Can cause lesion, mastitis adn abscess - CORRECT ANSWER MRSA"
"Area of pus which needs to be drained - CORRECT ANSWER Abscess"
"Affects up to 20% of postpartum women - CORRECT ANSWER Anemia"
"When women use these they are at a higher risk of weaning early - CORRECT ANSWER
Shields"
"These knowers seek information from a variety of resoruces - CORRECT ANSWER
Procedural"
"These knowers like to be be helped by someone who is similar - CORRECT ANSWER
Subjective"
"In lactogenesis III what can reduce supply? - CORRECT ANSWER Pressure"
"It is best to use few words with these people - CORRECT ANSWER Women in silence"
""Final Rule" on formula spring 2014 - CORRECT ANSWER FDA"
"May be prevented or delayed with longer duration of breastfeeding - CORRECT ANSWER
Diabetes"
"Can result in Sheehan's syndrome - CORRECT ANSWER Hemorrhage"
"May be indicator of sore nipples - CORRECT ANSWER Pacifiers"
"May cause lower rise of prolactin - CORRECT ANSWER Smoking"
"Late stage of hunger - CORRECT ANSWER Crying"
What duration of breastfeeding is associated with significantly reduced incidence of acute otits
media (AOM)? A) Any breastfeeding B) Up to 3 mos C) More than 4-6 months - CORRECT
ANSWER C) More than 4-6 months"
"Breastfeeding lowers the risk for the incidence of dental caries compared to children fed
nonhuman milk from a bottle. True of False? - CORRECT ANSWER True"
"Does breastfeeding lower the risk of NEC in preterm infants? - CORRECT ANSWER Yes"
"Is there a difference in the protective effect against SIDS between babies that are exclusively
breastfed vs. non-exclusively? - CORRECT ANSWER Yes, babies that are exclusively
breastfed have a stronger protective effect against SIDS"
"Does breastfeeding lower the risk for the incidence of malocclusion (misalignment of teeth)? -
CORRECT ANSWER Yes"
"True of False. Lactational amenorrhea, or the delay in return of menses after birth, is not
associated with exclusive breastfeeding. - CORRECT ANSWER False"
"What are the physical benefits of breastfeeding to the lactating parent? - CORRECT
ANSWER Lower risk of breast cancer, lower risk of ovarian cancer, reduced risk of Type 2
diabetes, reduced risk of cardiovascular disease"
"What are the 3 main steps of Evidence-Based Practice (EBP)? - CORRECT ANSWER Best
available clinical evidence, Clinical expertise, Patient concerns and needs"
"What are the benefits of breastfeeding for infants? - CORRECT ANSWER Protective against
respiratory infections, asthma, gastrointestinal infections and diarrhea, ear infections, dental caries, teeth misalignment, NEC and SIDS, obesity, diabetes, higher performance on intelligence tests"
"What are hypotonic lips in an infant? - CORRECT ANSWER Abnormally LOW muscle tone or
weakness in lips- may impact amount of suction, increase work of feeding, can contribute to milk loss and fatigue during feedings"
"What are possible issues due to facial hypotonia? - CORRECT ANSWER Decreased cheek
stability hindering seal on the breast, infant needs to create a greater vacuum to generate and sustain suction, this increases the work of feeding and can cause fatigue before feeding is complete."
"How do you assess cheeks on an infant? - CORRECT ANSWER Place a gloved finger inside
infant's mouth and place a thumb on the outside of the cheek to sense the thickness of the fat pads. With thin cheeks, finger and thumb almost touch."
"How can you identify weak, thin, or unstable cheeks during a feed? - CORRECT ANSWER
Cheeks will collapse while baby sucks. Also look for dimples."
"What method can be used to assist an infant with low facial muscle tone during feeds? -
CORRECT ANSWER Dancer hold- provide external support during feeding by using fingers
and hand to support infant's jaw and cheeks"
"What is micrognathia? - CORRECT ANSWER Abnormally small lower jaw"
"What is retrognathia? - CORRECT ANSWER Abnormally receding lower jaw"
"What can severe micrognathia (abnormal small lower jaw) and retrognathia (abnormally
receding lower jaw) be signs of? - CORRECT ANSWER Pierre Robin sequence"
"What can infant jaw clenching during feeding be a sign of? - CORRECT ANSWER
Hypertonia or a weakness in a different area (e.g. poor tongue or lip function)"
"What do you look for when assessing an infant's jaws? - CORRECT ANSWER Observe for
asymmetry, Identify micrognathia or retrognathia, Identify jaw grading, clenching, or tremors during feeding"
"How do you do an oral assessment of an infant's jaw? - CORRECT ANSWER Insert gloved
pinkie finger in corner of infant's mouth between posterior gum pads: 1. Count number of reflexive bites (chews) 2. Infant should respond with 10 chews per side 3. Observe difficulty producing reflexive bites or stress cues during assessment"
"What are 2 things that can be done to assist an infant while feeding to assist with jaw issues? -
CORRECT ANSWER 1. Provide external jaw support with a finger placed under bony part of
lower jaw to control/stabilize distance of jaw excursions 2. Identify feeding positions that emphasize postural stability (hip flexion, stabilize trunk) and maintain head extension to bring lower jaw closer to breast"
"What methods can be done to improve results of infant feeding issues due to jaw abnormalities,
weakness, or injury? - CORRECT ANSWER 1. Exercise jaws several times a day 2. Refer infant
for physical therapy or body work 3. Refer infant for speech or occupational therapy for assessment for feeding difficulties"
"costs to prevent needless deaths - CORRECT ANSWER less than $6 billion/year worldwide"
"suboptimal breastfeeding - CORRECT ANSWER accounts for more than 3,340 maternal and
child deaths a year, 80% are maternal"
"nursing a baby for a year or more - CORRECT ANSWER decreases by 10-15% the risk of
developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease"
"women who do not breastfeed - CORRECT ANSWER are at greater risk for myocardial
infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer"
"WHO and UNICEF three strategies - CORRECT ANSWER for increased breastfeeding
initiation and duration in every country: promotion, protection, and support"
"breastfeeding promotion - CORRECT ANSWER focuses on advantages of breastfeeding on a
personal, community, country, or global level"
"breastfeeding protection - CORRECT ANSWER focuses on government, manufacturer, and
social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc."
"breastfeeding support - CORRECT ANSWER focuses on the interaction of "helpers" with
family as well as program development and implementation"
"community expertise - CORRECT ANSWER variety of community expertise is needed to
promote, protect, and support breastfeeding"
"International models - CORRECT ANSWER for integrating breastfeeding promotion,
protection, and support as well as balancing technical information, programs, and protocols"
"CLC - CORRECT ANSWER nationally recognized designation awarded by the ALPP to those
who are exam eligible and pass the exam; have competenct verified"
"triggering oxytocin mechanism #1 - CORRECT ANSWER conditioned response - conditioned
milk ejection (let down) reflex
- was probably given too much importance in the years we didn't understand the other mechanisms
- conditioned over time and lasts a lifetime
- is faster for women who already have one from previous breastfeeding
- to condition response.. smell, touch, hear the stimulus"
"triggering oxytocin mechanism #2 - CORRECT ANSWER nipple stretching, happens with a
proper latch"
"triggering oxytocin mechanism #3 - CORRECT ANSWER baby hand massage, each hand
movement releases oxytocin"
"hormones of lactation - CORRECT ANSWER have an emotional/behavioral function as well
as making and moving milk; aggression, protection, bonding & trust"
"milk composition - CORRECT ANSWER is complex
- each species of mammal milk is different
- milk is "species specific""
"nest or cache - CORRECT ANSWER mammal species with high fat/protein and low water
content = infrequent feeds nest = bunnies cache = deer"
"carry, follow, or hibernate - CORRECT ANSWER mammal species with hither water content
milk have more frequent feeds carry = koala follow = elephants hibernate = bears"
"our culture - CORRECT ANSWER wants us to be nesters when it comes to feeding, but our
milk composition indicates that we should be carriers"
"the brain - CORRECT ANSWER most rapidly developing organ in human newborns; human
milk is the ideal fuel for brain growth"
"nursing pattern - CORRECT ANSWER should be frequent to accommodate human milk
composition"
"stages of making human milk - CORRECT ANSWER lactogenesis I, lactogenesis II,
lactogenesis III"
"lactogenesis I - CORRECT ANSWER secretory differentiation, placental hormones,
colostrum"
"lactogenesis II - CORRECT ANSWER secretory activation, after complete delivery of
placenta, rapid drop in progesterone, transitional milk"
"lactogenesis III - CORRECT ANSWER lactation, galactopoesis, prolactin from frequent
nipple stimulation, frequent removal of milk, mature milk"
"breastmilk composition - CORRECT ANSWER human milk changes continually, makes it
impossible to obtain a single representative sample of milk"
"diarrhea mechanisms 1 - ph of the gut - CORRECT ANSWER breastfed babies' gut is more
acidic while formula-fed babies' guts are more neutral/basic gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies"
"diarrhea mechanisms 2 - low iron in the gut - CORRECT ANSWER relatively low iron
content in human milk"
"diarrhea mechanisms 3 - presence of bifidus factor - CORRECT ANSWER promotes
intestinal presence of lactobacillus bifidus that maintain the low pH and crowd out pathogenic organisms"
"diarrhea mechanisms 4 - presence of hormones - CORRECT ANSWER hormone like factors
and growth factors that stimulate growth and development of the GI tract and GI motility, such as:
- GI hormones
- prolactin
- EGF (epidermal growth factor)
- prostaglandins"
"diarrhea mechanisms 5 - antibodies - CORRECT ANSWER such as SIgA bind to microbes in
the baby's intestinal tract and prevent them from being absorbed into the rest of the body. mother's IgA has been found to protect against the development of NEC in preterm infants. maternal IgA shapes the host-microbiota relationship of pretern neonates that IgA in maternal milk is critical and necessary factor for the prevention of NEC"
