pz vol1 test taking

by Marie Biancuzzo, rn Ms iBclc

A Self-Learning Package

APPROVED3.6 Contact Hours for Nurses

Test-Taking Strategies: Keys for Lactation Exam Success


© 2006 WMC Worldwide

About the Author

Marie Biancuzzo is the author of the best-selling book, Breastfeeding the Newborn: Clinical Strategies for Nurses (Mosby, 2003). The founding editor of AWHONN Lifelines, Marie is the sole author of over 50 articles, many published in peer-reviewed journals. Her articles have covered topics such as breastfeeding, labor/delivery and competency-based education.

Marie developed Marie Biancuzzo’s Lactation Exam Review, a course she teaches each year in several major cities across the country. She has been certified by the American Nurses Association as a continuing education specialist, and she has completed special training in testing procedures. She was chosen to serve on the National Council Licensure Examination (NCLEX) panel, a group of experts that develop the RN licensing exam. Marie’s ability to blend clinical expertise and scholarly achievement has been recognized by national organizations which have awarded her leadership positions and multiple sub-specialty certifications. Having taught literally thousands of novices and experts across the United States, Marie has earned praise for her warmth, enthusiasm and interactive teaching style.

Marie currently provides consultation for hospitals, universities and corporations on perinatal issues. Past clients include the US Navy, several state WIC offices and the national March of Dimes Foundation. In addition, Marie serves as a representative on the United States Breastfeeding Committee and as President of Baby-Friendly USA.

Formerly the breastfeeding and lactation coordinator for the University of Rochester Medical Center in Rochester, NY, Marie has held faculty appointments at the University of Rochester School of Nursing and at Georgetown University School of Nursing in Washington, D.C. Throughout most of her years in advanced practice, Marie has maintained a per diem appointment as a staff nurse, practicing for many years in all areas of perinatal nursing.

Test-Taking Strategies: Keys for

Lactation Exam Success

by Marie Biancuzzo, rn Ms iBclc

A Self-Learning Package



Gold Standard Publishing

Graphics and Layout: Breastfeeding OutlookCover Design: Breastfeeding OutlookPhotographs: Courtesy Mr. and Mrs. David Haskell, Mr. and Mrs. Chris Lewis

A Note to the ReaderThe author and publisher have made every attempt to check content for accuracy. Because the health care sciences are continually advancing, our knowledge base continues to ex-pand. Therefore, we recommend that the reader check product information for changes in dosages, contraindications, and other information about any medication or intervention.

A Request to the ReaderWe invite your comments and constructive suggestions. If you find an error, please notify us at [email protected].

Copyright 2006

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without prior written permission of the publisher.

The most recent version of this document may always be obtained at www.breastfeedingoutlook.com

Breastfeeding OutlookBox 387Herndon VA 20172-0387www.breastfeedingoutlook.com

ii

ISBN # 978-1-931048-06-4



Welcome to The PassingZone Series!

We know you’ll want to take advantage of the convenience and affordability of earning contact hours and CERPs when you want, where you want!

The PassingZone series gives nurses, lactation consultants, childbirth educators, and others a great opportunity to earn continuing education credits toward licensure or certification renewal. You’ll appreciate that you pay only for what you need. If you need just the learning package, you’ll pay for nothing more. If you lend your package to your colleagues, they’ll pay only for earning the continuing education credits!

We’ve enclosed materials so that you can start earning credits right away! It’s so easy! Just complete the steps below and submit the required forms with payment, and you’ll be on your way to earning credits.

1. Complete the 10-question true/false pre-test.2. Read the entire self-learning package.3. Complete the post-test on your own, without assistance from anyone else. Copies

of the post-test and answer sheet are downloadable from our web site at www.breastfeedingoutlook.com

4. Write your post-test answers on the answer sheet found on page 38. (You will return the answer sheet, not the test page.) You may also download copies of the answer sheet from our web site at www.breastfeedingoutlook.com .

5. Answer all questions carefully. Remember that payment is for the opportunity to earn credits, and it will not be refunded if you do not pass the post-test.

6. Complete the evaluation of the package found on page 39.7. Enclose payment. We accept checks drawn on US funds, as well as Visa, Mastercard,

American Express, and Discover.8. Mail the answer sheet, package evaluation, and payment to: Breastfeeding Outlook, Dept. CE PO Box 387 Herndon VA 20172-0387

Allow up to 4 weeks for us to respond to your application for continuing education recognition.

We hope you find this a great learning experience!

Continuing Education Approval

Approved for 3.6 contact hours for nurses

Note: The number of contact hours may increase or decrease slightly when the packages are re-approved, as required by our approval agencies. Check our web site at www.breastfeedingoutlook.com for updates.

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Common Questions About the PassingZone Series

Q: Where do I send my completed post-test?A: As specified on the answer sheet, you should mail your post-test and other materials

to us here at WMC Worldwide, Dept. CE, PO Box 387, Herndon VA 20172-0387. Please do not send your materials to your certifying or licensing agency; they are not involved in the preparation or processing of your post-test!

Q: Can I submit the post-test any time?A: Yes and no. Learning packages are approved for 3 years at a time. Historically, we

have always sought and obtained re-approval for the self-learning packages. However, we are reluctant to commit to this for all packages all of the time. Try to complete your package within 3 years of when you get it.

Q: Can I do the entire self-learning program at home?A: Yes!

Q: Other organizations charge an additional $25 fee to people who use borrowed booklets to earn continuing education recognition. How much extra will you charge my friend for using my booklet when she applies for continuing education recognition?

A: We charge no additional fee! She will pay the same amount for continuing education as you or anyone else.

Q: How many questions do I need to answer correctly to pass the post-test?A: The passing level is 80%.

Q: How and when will I find out about my performance on the post-test?A: We will send both our response and your results no later than four weeks of when we

receive your completed post-test. Usually, we are able to send a response sooner than that.

Q: If I fail the test, will I have to pay to take it again?A: Yes, but only a $10 processing fee.

Q: How can I find out about updates or modifications to the package? A: Check our web site at www.breastfeedingoutlook.com for information. Updates and

other modifications will be listed there.

Q: Can we contact you if we have questions or comments?A: Yes, please do! We like to hear from people who purchase our publications. E-mail us

at [email protected] or write to us at WMC Worldwide, PO Box 387, Herndon VA 20172-0387. We discourage phone calls, which tend to be more time-consuming for our staff and would eventually force us to raise our publication prices.

Q: I really enjoyed the self-learning package. Do you publish others? A: Yes! We have several packages already available and new ones are always in

development. Visit our web site at www.breastfeedingoutlook.com to see what’s new!

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© 2006 WMC Worldwide v

Preface

Preparing for a comprehensive exam is one of the most daunting endeavors I’ve ever undertaken. When I am preparing, I am sometimes rather overwhelmed by two thoughts: I can’t possibly remember everything and I haven’t studied everything I need to have studied.

I can’t possibly remember everything I’ve ever learned about the topics on the exam. Yet, I know it is a comprehensive exam, which, by definition, means that anything I’ve ever learned is fair game. The thought of reviewing–far less actually remembering—all of the information that I’ve accumulated over several years is enough to set my head spinning.

At the same time, I realize that identifying, reviewing, and re-mastering the once-learned information actually may be the easy part. The hard part seems to be wading into a comprehensive exam that is complete, far-ranging, broad-based, and virtually limitless in its scope. There very well may be test items that address sub-topics about which I have little or no knowledge. I worry that if I didn’t know something existed, I didn’t study it; therefore, I can’t possibly pass the exam. Or can I?

While I was developing the syllabus for Marie Biancuzzo’s Lactation Exam Review course, I realized that I couldn’t possibly teach participants everything they need to know to pass a comprehensive lactation exam. I couldn’t cover all the topics that might be on the exam or infuse them with all of the facts they might need to know to pass the exam. However, I could teach them how to prepare or the exam, how to correctly write down what they actually do know, and how to figure out a correct response when they might not have mastered the material being tested.

This self-learning package came about because there is not enough time in the course schedule to address some of the finer points of preparing for and passing a comprehensive lactation exam. In teaching people how to prepare for and take the exam, I’ve given up on the idea that I can teach everything about a topic, even one I know as well as lactation. Instead, I’ve come to espouse the idea that, as test-takers, we need to learn the basics about the topic and apply those basic concepts to actual test items.

I hope that this short learning package will help you become a better test-taker.



Goal of This Package

To assist those who plan to take the IBLCE exam to prepare for and successfully complete the exam.

Instructional Objectives • Plan how to get to the exam site and avoid last-minute snags.

• Describe general study strategies for preparing for a comprehensive exam.

• Describe how to effectively prepare for items on the IBLCE exam.

• Describe how to correctly select correct options when taking the IBLCE exam.

• Given one of the 4 types of distracters, use effective strategies for selecting the right answer.

• Recognize and avoid the pitfalls of photo items.

• Describe specific techniques for selecting correct responses when you know the material, when you are uncertain, and when you are completely stumped.

AudienceThis self-learning package is appropriate for:

• Staff nurses

• Advanced practice nurses

• Dietitians

• Lactation consultants

• Childbirth educators

• Others preparing for the IBLCE exam

Continuing Education Approval This self-learning package carries continuing education credit for multiple disciplines, as specified on page iii.

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Table of Contents

PRE-TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiiMASTERING THE MUNDANE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Site Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 When . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Where . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 What to Bring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 How Much . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Last-Minute Snags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1PREPARING FOR A COMPREHENSIVE EXAMINATION . . . . . . . . . . . . . . . . . 2 Study Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 What to Expect on the Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The Examination Itself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5HOW MULTIPLE-CHOICE EXAMINATIONS ARE CONSTRUCTED . . . . . . . . 6 Components of Each Item . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The Stem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 The Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Types of Multiple-Choice Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Recognition and Recall Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Call to Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Graphics Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Types of Distracters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Outdated Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 “Echo” Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Sounds Like . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Looks Like . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21TACKLING THE IBLCE EXAMINATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 When You Know the Answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Read Carefully; Write Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Answer the Easy Items First . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Note the Qualifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Stick With Your First Answer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 When You Feel A Little Uncertain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Bolster Your Powers of Recall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Deal with Distracters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 When You Are Completely Stumped . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Guess! You Might Be Right! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25OKAY, YOUR TURN! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28APPENDIX A: PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29APPENDIX B: KEY FOR PRACTICE QUESTIONS . . . . . . . . . . . . . . . . . . . . . . 33APPENDIX C: IBLCE EXAM BLUEPRINT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34APPENDIX D: AGENDA FOR EXAM DAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35APPENDIX E: BOOKS THAT HELP YOU TO PREPARE FOR EXAMS . . . . . . 35POST-TEST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36POST-TEST ANSWER SHEET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38EVALUATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39ORDER FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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Pre-test

Mark each of the following as TRUE or FALSE:

1. You are penalized for guessing on the IBLCE exam.

2. You are not allowed to make stray marks on the exam booklet.

3. Photo items are presented in a slide show format.

4. All of the photo items show something pathological.

5. Your first guess is almost always your best guess.

6. The entire examination consists of 200 items, most with 4 options but some with 3 or 5 options.

7. Look-alike and sound-alike distracters are good test-item discriminators.

8. The passing score on the IBLCE exam varies from one year to another.

9. “Translating” is an effective study technique.

10. The items that use the LEAST language are all grouped together on the IBLCE exam.

Answers to the pretest can be found at the bottom of this page.

Answers: 1. False, 2.False, 3. False, 4. False, 5. True, 6. True, 7. True, 8. True, 9. True, 10. True

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© 2006 WMC Worldwide 1

Mastering the Mundane

Before you do anything too fancy to prepare for the exam, you will need to master the mundane. However boring it may be to do, you will need to look up site details, write them down, and use some simple strategies to reduce last-minute snags.

Site DetailsAfter you have read the Candidate Guide and submitted your application to take the exam, the International Board of Lactation Consultant Examiners (IBLCE) will send you information related to your testing site. Most people are tempted to ignore this information until the day of the exam. Resist that temptation! Go. Get your Candidate Guide and related materials. Use the worksheet below to make sure you really know the when, where, what, and how of your exam site.

I can’t overemphasize the importance of getting all of your ducks in a row prior to taking the exam. First, the cost of the exam itself can be quite burdensome, as can the cost of transportation and accommodations,if the exam is available only in a city far from home or if you need to travel to a preparatory or review course. Second, and perhaps more important, is the fact that you have only one shot at passing this exam each year. Do everything you can so that things go smoothly on exam day, because this exam is only offered on one day each year. Don’t blow your chance by not being prepared. Please take the time to really master the mundane details associated with getting to the exam.

Last-Minute Snags• Ifyouhaveanyquestions,callIBLCEasmanydaysbeforethetestdayaspossible.

IBLCE’s phone number is 703-560-7330. Better yet, save yourself the cost of a long-distance call and the time you’d spend waiting on hold. Visit the IBLCE web site at www.iblce.org. Many of the most common questions are answered there.

• Findtheexamsiteseveraldaysbeforetheexam.Besurethatyouareconfidentthatyou can drive the right roads, take the right trains, etc. Make sure that you know how long the trip will take at the particular time of day you will be traveling.

• Severaldaysbeforetheexam,askafriendifheorshewillbeabletogiveyoualiftifyour car won’t start or if you encounter some other transportation problem on the day of the exam.

• Settwoalarmclocks.Ifyouthinkthere’sachanceyoumightsleepthroughbothofthem, ask a friend to call you on the phone at the time you’d need to get out of bed on exam day.

• Don’tdrinktoomanycupsofcaffeinatedcoffeeorsoftdrinksbeforetheexam.TheIBLCE is a timed exam, and you’ll waste precious time getting up and going to the restroom. Also, one of the proctors will be required to escort you each time you go, so if it bothers you to know that someone will be hearing you tinkle, reduce your caffeine intake to eliminate or reduce potty-stops during the exam.

• Allowplentyoftimetogettotheexamsiteandpark.Ifyou’rerunningbehind,you’llbe a nervous wreck before you even sit down in the exam room. On the other hand, if you’re a little early, you can always spend a few minutes going over your notes.

You have only one shot

at passing this exam each year!

!



Preparing for a Comprehensive Examination

Let’s face it, preparing for any comprehensive examination is a daunting task. To prepare effectively, you need to have good study strategies and you need to know how the exam is put together.

Study StrategiesTo some extent, the study strategy or strategies that you select will depend on your own learning style. Some people learn best by studying alone; others learn best by studying with a partner or a group; still others learn best by combining these two strategies.

A variety of study strategies can be employed, and the strategies you use should be determined by the type of information you need to master. For the IBLCE exam, you

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WhenDate of the IBLCE Exam: ____________________________________________Registration is at: _____________________________________________ o’clock.Exam starts at: _______________________________________________ o’clock.If I am late, the consequence is: ________________________________________

Where Address: __________________________________________________________Name of Building: __________________________________________________Where to Park: _____________________________________________________Other transportation notes: _____________________________________________________________________________________________________________________________________________________________________________

What to BringThree things to bring to the exam are:1.) ______________________________________________________________2.) ______________________________________________________________3.) ______________________________________________________________

HowHow do I get there? (Look at a map and figure it out. Or, visit www.mapquest.com or www.mapsonus.com. and enter the address you will start from on the morning of the exam and the address of the test site.)

How MuchHow much will it cost for parking and tolls? Will I need exact change to get through any toll booths along the way? How much?Will I need money for lunch? How much?

Table 1. Getting the facts before going to the exam.



need to know basic facts and terminology, methods and procedures for using equipment, and concepts and principles that guide breastfeeding and lactation management throughout the childbearing cycle.

After you have mastered the basic knowledge, you’ll need to be able to apply it. Most of the exam items will focus on application; that is, they will require you to use your knowledge and comprehension of a topic in order to identify what action should be taken.

Study strategies will be discussed in more detail later in the learning package. Meanwhile, you’ll need to get a basic grip on what to expect on the IBLCE exam.

What to Expect on the ExamKnowing the details of the exam is critical to your success. Below, I’ve tried to remove some of the mystique about how to pass the exam by explaining the exam itself and listing the questions that people frequently ask in my review course.

The Examination ItselfWhat the Test Looks LikeTo effectively prepare and successfully complete the exam, you’ll need to be able to visualize the test beforehand. You’ll be more successful if you correctly anticipate the topics that will be covered, the level of difficulty, the timeframe, and the format of the test.

Topics CoveredThe IBLCE exam includes 13 topics: anatomy; physiology and endocrinology; nutrition and biochemistry; immunology and infectious disease; pathology; pharmacology and toxicology; psychology, sociology, and anthropology; growth parameters and developmental milestones; interpretation of research; ethical and legal issues; equipment and technology; techniques; and public health and advocacy. Furthermore, the test addresses issues that are chronologically important; for example, it asks about issues from preconception until after weaning. Additional information and an outline are included in Appendix C. For your convenience, examples and the number of items in each exam section are provided there.

Level of DifficultyThe IBLCE exam is an entry-level examination. You should not need to read 20 textbooks and be in clinical practice for 20 years in order to pass it. Most of the items on the exam pertain to situations that are commonly encountered in clinical practice.

Some examination items require only simple recall of facts. For example, an item may require you to know what vitamin deficiencies are likely to be experienced by a breastfeeding mother. These are the easiest items. However, most of the items require you to take action, typically making a decision, making a recommendation or identifying a problem. As you might surmise, you can’t take action unless you have mastered the simple, straight-forward facts. That’s why it is important for you to know the fundamentals of each exam topic.

Format and TimeframeThe examination consists of 200 items. It is administered in two parts. In the morning, you will have 3 hours to answer 100 text-only items. Then, you will have a one-hour

3



break for lunch. In the afternoon, you will have 3 hours to answer 100 items, 75 of which will involve photos and 25 of which will be text-only. That means that in the morning as well as in the afternoon, you can allow yourself only a little less than 2 minutes for each item. This doesn’t mean that you should watch the clock anxiously or check it after each item. What it does mean is that you should plan your test-taking approach so that you can make the most of your limited time.

Text-only ItemsThere are 125 multiple-choice, text-only items. Most of the items ask you to select your response from 4 options. Occasionally, 3 or 5 options will be available.

Photo ItemsThere are 75 items for which you will look at a photo in order to choose your answer. In years past, the photos were presented as slides flashed on a screen, but that’s no longer the case. When you take the exam, you will receive your own booklet of photos. Each photo will be numbered to match the corresponding item in the exam booklet.

Time in Relation to FormatIf you’re like me, it will take you longer to answer the photo items than to answer the text-only items. Therefore, in the afternoon, I buzz through all of the text-only items first, so that I can devote the remaining time to the photo items. Otherwise, I’d be obsessing over the photo items, and I might not leave myself enough time to answer all of the text-only items.

What Can You Do or Not Do? In order to most effectively tackle the exam, it’s critical for you to know what you can and cannot do. Here are some important things to know.

You can write comments.The IBLCE proctors will give you a critique sheet on which you can write comments. Don’t be shy; when I took the exam, I wrote comments that completely covered the front and back of two pieces of paper! I wrote comments about test items that were unclear, about those that I felt strongly had more than one correct answer, and about those for which I could not find a correct answer among the options. If you encounter any of these problems—or any others—you should write your comments on the critique sheet. IBLCE will review all of the comments that are submitted by people taking the exam, and if there are a substantial number of comments about an item, it may not be counted in the score.

The only caution I might offer here is that it does take time to write your comments. I generally write the word “Comment” next to an item that I don’t like, and, if time permits, I go back and write my comments after I have completed the exam.

You can write in the exam booklet.You can – and should – write in the test booklet. This enables you to cross out answers that you immediately know are incorrect, flag items that you’re uncertain of, and write brief notes to yourself so that you can go back and re-think items, if needed.

Your exam booklet will not be used to grade your test, so scribble on it all you want. You will mark your answers on a computerized sheet. It’s one of those fill-in-the-circle things like those you used in grade school.

You can guess.Whenever you take a multiple-choice examination, it’s important to know whether or

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You can – and should – write in the test booklet.

!



not you will be penalized for guessing. In the case of the IBLCE exam, you will not be penalized for guessing. Therefore, even if you really don’t know the answer, you should mark a response. In that case, you should guess.

Frequently Asked QuestionsDuring the time I have been teaching Marie Biancuzzo’s Lactation Exam Review, I have been asked many questions about the details of the examination. Some are addressed in the IBLCE’s Candidate Guide, but others are not. Here, I’ve compiled a list of questions that people often ask, and I’ve called IBLCE to confirm the answers. I’m fairly confident that I’m giving you accurate information. However, to be absolutely certain that these answers are up-to-date, I recommend that you e-mail IBLCE directly and ask them yourself. E-mail [email protected] for updates, clarifications or answers to your questions.

Q: I live in Ontario (Canada) and I want to go to Michigan (United States) to take the exam. Is that okay?

A: Yes. The IBLCE examination is an international exam. According to IBLCE, the same examination may be taken in any country where the test is administered. You do not need to take it in the country where you live.

Q: How will I know what I got wrong on the exam?A: You will not know the exact items that you missed. However, IBLCE will send you

a breakdown of your score that will describe how well you performed in each of the topic and chronological areas. (See Appendix C for details about these areas.)

Q: Can I take the exam in Spanish?A: Absolutely. It is available in several different languages. Be sure to request the specific

language you want when you sign up for the exam.

Q: What is the passing score on the IBLCE examination?A. The passing score varies from year to year based on IBLCE’s statistical analysis of the

exam items. However, the passing score has historically hovered around 65%. See IBLCE’s web site for an explanation of how the passing score is calculated.

Q: Of those who take the exam, how many pass?A: The vast majority of candidates do pass. The pass rate differs from year to year. Visit

IBLCE’s web site at www.iblce.org for more information.

Q: Is there a penalty for guessing if I don’t know the answer?A: No. Go ahead and guess! You might be right!

Q: Will the photos be shown as slides on a screen?A: No. In the past, the photos were shown on a screen, but now each person is given a

booklet of photos.

Q: May I write in the test booklet?A: Yes, and you should! Writing often helps to clarify your thoughts.

Q: What about those pesky “LEAST” items? You know, the ones that give a situation, then ask, “Which of these is LEAST likely to” do something?

A: They are pesky, aren’t they? Fortunately, the “least” items are all grouped together on the exam. I like to deal with those by writing (on the test booklet) “yes” next to the 3 that are possible, and “no” or “maybe” next to the one that I don’t agree with or don’t like. The one that I don’t agree with is the LEAST likely. Be patient, and keep reading to get more help with this sort of test item.

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How Multiple-Choice Examinations are Constructed

In order to study effectively and successfully complete the exam, it’s helpful to know how multiple-choice exams are constructed. Let’s talk about the basics.

Components of Each ItemThe thing that most people call a “question” is really called an “item.” An examination item consists of the stem and several possible response options.

The StemThe stem is the first part of the test item. It contains the information on which the question is based. Stems come in three formats: (1) the simple question, (2) the partial sentence (sentence fragment), and (3) the best answer.

The Simple Question One kind of stem is the simple question. Here is an example of a simple question stem:

Who was the 40th President of the United States? a. George H.W. Bush b. George W. Bush c. Ronald Reagan d. Gerald Ford

The simple question format is a good one because the stem expresses a complete thought. By reading the simple question, you are immediately able to start formulating a response in your head, and perhaps even before you read the options, you know that the answer s

c) Ronald Reagan.

The Partial SentenceThe partial sentence format provides a sentence fragment in the stem and each of the options would complete the sentence. Here is an example of this format:

The instructor for this course is a. Marie Biancuzzo. b. Debi Bocar. c. Ruth Lawrence. d. Derrick Jelliffe.

Note that the partial sentence structure is different from the simple question. Below, the same material is being tested, but the simple question is used:

Who is the instructor for this course? a. Marie Biancuzzo b. Debi Bocar c. Ruth Lawrence d. Derrick Jelliffe

The Best AnswerThe “best answer” format has the “best” qualifier in the stem. This format is difficult, because all of the options are technically correct. However, one of them is better than

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all of the others. Variations of this format include such constructions as “the first action,” “the most important,” “the primary reason,” and “the least likely.” Here’s an example of the “best answer” format:

Which of the following is the best utensil for eating yogurt? a. knife b. spoon c. fork

Heaven knows, if you’re clever and patient, you could probably load your yogurt onto a knife and eat it that way. I cheerfully admit that I’ve eaten yogurt with a fork when I’ve been on the road and that was the only utensil I had with me. But the best utensil for eating yogurt is, clearly, the spoon.

Okay, are you in the groove of this? Now take a look at a “first action” question:

In the morning, which of the following would you do first? a. take a shower b. shut off the alarm c. grab your keys d. get dressed

You probably do all of these things. But the item asks which action you would do first. There are several simple strategies you can use to answer this item correctly. The first thing you should do is to focus on the word first! Underline it. Honestly, so many people blow right by that word, then get befuddled trying to figure out which actions they would do and which they would not do. Indeed, the item acknowledges that all of these actions are appropriate morning activities; it only asks which would be done first. Okay, so let’s say you didn’t know how to answer this. With some simple logic, you could figure out that it would be annoying to hear the alarm clock buzzing while you’re in the shower. You could reason that a person wouldn’t take a shower after putting on clothes. It’s certainly possible to grab your keys while you’re still in your nightgown or naked, but would you? Probably not. As you study for the exam, practice walking yourself through items in this manner when you’re uncertain about the order of the actions.

Okay, now let’s tackle those pesky “least” constructions. I don’t like taking tests with this construction, and frankly, I don’t write items with it. IBLCE does, so let me show you what they are and how to effectively deal with them.

Here’s an example from the 2004 IBLCE Candidate Guide:

After several years of planning, a hospital will be implementing a new breastfeeding protocol. Which of the following components of the protocol is least likely to promote breastfeeding success?

a. early initiation of breastfeeding b. progressive lengthening of time at breast c. nighttime breastfeeding d. supplementation, if medically indicated

If you are like me, you may get all tangled up in this item. To effectively deal with it, force yourself to scribble no, yes, or maybe next to each option. In fact, let’s do that right now. Will early initiation of breastfeeding promote breastfeeding success?

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Unquestionably, yes. Will progressive lengthening of time at the breast promote breastfeeding success? No. Will nighttime breastfeeding promote breastfeeding success? Yes. Will supplementation promote breastfeeding success? This is where it gets hairy. My first inclination is to say no, because it’s hard for me to imagine that supplementation is going to “promote” breastfeeding, regardless of whether or not it is medically indicated. However, the item is asking for the option that is LEAST likely to promote breastfeeding success. If I think about this for a moment, I can concede that if the hospital unit is supplementing only when medically necessary, then plenty of newborns will be spared unnecessary or routine supplementation, thus promoting breastfeeding success. In contrast, we can be most certain that progressively lengthening the time at the breast (as we used to say in the old days, “Two minutes today, 3 minutes tomorrow, 5 minutes the next day”) would not promote breastfeeding success. Therefore, option (b) is the best response.

The OptionsFollowing the stem, there are several options. Usually, there are 4 options, but occasionally there are 3 or 5 options. Among these options, you’ll find only one correct answer; the other options are called distracters. Qualifiers in the options are important to note, as they often provide valuable information.

One Correct AnswerNo joke! The option that you want to select is the right answer! The more right answers you give, the higher your score will be!

The DistractersDistracters are the incorrect options. They are designed to be similar to the correct answer. Here’s an example of an item followed by the correct answer and 3 options that are similar:

The president who called himself a “compassionate conservative” is a. George H.W. Bush. b. George W. Bush. c. Ronald Reagan. d. Abraham Lincoln.

In this example, all of the options are Republican presidents. Option (d) is an enticing distracter because Abraham Lincoln freed the slaves; thus, he might be thought of as compassionate. Option (c), Ronald Reagan, was a central figure in calling for the removal of the Berlin Wall; thus, he might be thought of as compassionate. But perhaps you know that the answer is neither Reagan nor Lincoln. You know it was one of the Bush presidents, but you can’t remember which one. In that case, option (a) is a very effective distracter because it is so similar to option (b), which is, of course, the correct answer. A good distracter is one that is very similar to the right answer.

Qualifiers in the OptionsQualifiers in the options are often used to make one option more right and the others more wrong. Knowing that the subject is a “first-time” mother or a “premature” baby should give you specific information. The following item shows how an option’s qualifier can help you determine the answer:

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Which of the following would require further follow-up? a. a 12-hour-old breastfed baby with jaundiced skin b. a breastfed baby with several soft, flocculent stools each day c. a 3-month-old breastfed baby who has 2 consecutive days without a stool d. a breastfed baby who has a vigorous Babinski reflex

In this example, you might recognize that soft, flocculent stools are typical for breastfed babies and that all babies should have vigorous Babinski reflexes. Having 2 consecutive days without a stool would not be worrisome for a 3-month-old, although it would be a cause for concern in the case of a newborn. Finally, jaundiced skin at 12 hours is a sign of pathology and requires follow-up. If the option were “a baby who has slightly jaundiced skin at 3 days,” this would not be the correct answer; at that age, it would not be worrisome. The qualifiers in these answers require you to know what would be appropriate or inappropriate for infants at specific ages.

Types of Multiple-Choice ItemsBasically, the exam gurus of the world have developed six types of multiple-choice items. We won’t discuss three of those types (comprehension items, reading and reasoning items, and calculation items), because they’re not on the IBLCE exam. Here, we’ll focus our attention on those types that you will see on the IBLCE exam: (1) recognition and recall items, (2) judgment items, and (3) application items.

Recognition and Recall ItemsRecognition and recall items are used to assess knowledge of basic facts. These items force you to recall or recognize the correct answer when it is surrounded by similar but incorrect options. Let’s take a look at an example and some strategies for dealing with these types of items.

Here’s an example of an item that requires recognition and recall.

All of the following are hotel chains except a. Holiday Inn. b. Days Inn. c. Hampton Inn. d. Roadside Inn.

In order to choose the correct answer, you would need to recall that you’ve seen or heard of the Holiday Inn, the Quality Inn and the Hampton Inn. You might also recognize that Roadside Inn is a distracter.

Strategies for Preparing for Recognition & Recall ItemsThere are many strategies to help you recall and recognize information. The ones that follow are based on Judith Meyers’ suggestions from her book, The Secrets of Taking Any Test.1 I have adapted the information about kinesthetic cues from Marie Biancuzzo’s Lactation Exam Review to demonstrate the usefulness of this technique.

Distributed PracticeAccording to Meyers, most people memorize information best when they digest it in small chunks. This is called distributed practice. Meyers suggests that you use 3 x 5 index cards, because each one holds only a small amount of information. In addition, you can use your cards whenever you have a few spare moments, such as when you’re on the train commuting to work.

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Divide the MaterialMuch as I hate to say it, some of the information required to pass the exam needs to be learned through simple rote memorization. For example, you must memorize the four vitamins that are fat-soluble. I’d be willing to wager that many test items related to the basic sciences—anatomy, physiology, and microbiology—require simple memorization.

Meyers reports that memorization is most successful when long lists are broken into shorter ones. Short lists of 7 or any odd number of facts are easiest to remember. For example, you may find it difficult to memorize all of the muscles of the tongue. However, the task becomes much more manageable when you ask yourself to remember the three intrinsic muscles and the five extrinsic muscles of the tongue.

TranslateTranslate what you need to learn into practical information that you can imagine in your own life. That is, attach some meaning to it so that you can successfully form an association between a word or concept and its meaning. For example, if you stumble over distinguishing the independent variable from the dependent variable, focus on the “i” words. The independent variable is the intervention that is manipulated by the investigator. This is a trick that has worked well for me.

Visual CuesVisual cues also can help you memorize information. The act of writing can help you memorize information because you are actively engaged in an activity and you can visualize what you have written. For example, I sometimes write a short list of items that I need at the grocery store. Even if I leave the list at home, I’m more likely to remember the groceries I need just because I wrote them down. Sometimes, I can even visualize the words as they appeared on the paper. Similarly, if you have trouble remembering all of the functions of lactoferrin, write a brief list or short paragraph. The act of writing will help you to remember this information.

Auditory CuesAuditory cues are helpful for all of us, but people who are auditory learners especially need them. To create auditory cues, you might simply read material out loud to yourself; as a result of doing so, you might be able to “hear” yourself giving the right answer when you are taking the exam. Another way to create auditory cues is to give your notes to a study partner who can ask you questions that you answer out loud. A third way to create such cues is to listen to the information on audiotapes or compact discs.

Kinesthetic CuesNo one ever suggests kinesthetic (or sensory) cues, but I like to use them. For example, when I teach my review course, I teach participants a kinesthetic cue to help them remember the locations of the milk lines. I show the lines in a photo, and then I ask participants to poke their own bodies in those seven places where the supernumerary nipples are likely to appear along the galactic band. Participants have told me that feeling those pokes helped them to remember where the milk lines are when they have encountered the topic on the exam.

MnemonicsMnemonics are memory tricks. The most common type of memory trick is the acronym, a word that is created by using the first letter of each of the key words. For example, a popular tool for remembering the names of the five Great Lakes is the acronym “HOMES,” which stands for Heron, Ontario, Michigan, Erie, and Superior.

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Mnemonics are memory

tricks.

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Other mnemonics use the first letter of each word to be memorized, but substitute other words to form a memorable sentence. In health care, a popular mnemonic is used for the 12 cranial nerves: On Old Olympus Towering Tops, a Finn and German Viewed Some Hops. This memory trick reminds the learner of the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, acoustovestibular, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves.

I learned that mnemonic when I was in a biology class more than 30 years ago, and I can still repeat it, as well as the names of the nerves it helps me to remember! Interestingly, when I took the IBLCE exam, I had to repeat this mnemonic to myself in order to answer one of the items.

Rhyming words are also mnemonics. Did you ever have trouble opening an oxygen tank? One night, I was working in the operating room and I needed to use the portable oxygen tank. The patient’s status was critical, and I was nervous. The oxygen tank was closed very tightly, and as I turned it, I couldn’t tell if I was opening it or closing it. Then, I remembered the tip my father had told me about opening jars and other household items: “Righty tighty, lefty loosey.” Sure enough, turning to the left opened the oxygen tank. Another example of a rhyming mnemonic is Dr. Marianne Neifert’s advice for managing mastitis: “Heat, rest, empty breast.” If you need to answer an exam item about managing mastitis, this mnemonic may prove to be very helpful. With a little thought, you can probably make up your own mnemonics for those topics that you find difficult to memorize.

Strategies for Correctly Answering Recognition & Recall ItemsKnowledge of plain, straightforward facts may be best accomplished through techniques that promote rote memorization. In my experience, some people make the mistake of trying to master complicated cognitive information before they have really nailed the basic facts. If you find yourself not knowing the definition of a key word or not being able to create a short list of things related to the word, you need to take a step back and master those simple, straight-forward facts. For example, can you define the word “mastitis,” and can you list several of its signs and symptoms? If not, you’re going to have difficulty answering more complicated items that require you to take action in response to the condition.

To me, the most basic skill of word knowledge is learning the Latin or Greek prefixes, roots, and suffixes. More than 90% of words in a medical dictionary have Latin or Greek derivations. If you were asked to look at a diagram and identify the pterygoid muscles, it would help to know that the Greek word pterygodes means wing. Armed with that knowledge, you’d immediately recognize these wing-shaped muscles, which are used when the infant suckles. Best of all, you’ll have some clue about what a word means even if you’ve never seen it before. The longest word in Gould’s Medical Dictionary is Hepati-cocholangiocholescystenterostomies. With a good understanding of ancient derivations, you could break this up into hepato-cholangio-cholescyst-entero-stomies and immediately know that it means the surgical creation of connections between the gall bladder and the hepatic duct, as well as the intestine and the gall bladder. As you can see, this skill can be very handy during an exam when you are faced with a word you don’t know. If you don’t have a clear command of the Latin and Greek prefixes, roots and suffixes associated with biology, chemistry, medicine, surgery, and pharmacology, you need to develop your knowledge in this area, pronto. It’s fairly easy. Flash cards are an excellent tool for mastering this material.

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More than 90% of words in a medical dictionary have Latin or Greek

derivations.

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Comprehension is one notch above knowledge. Comprehension requires you to put simple facts together and figure out something that enables you to take some action. Below, you’ll see how this exam will require you to use both knowledge and comprehension in order to take an action.

Call to Action ItemsYou have already heard of judgment questions and application questions. These two types of questions are classified separately by professional item-writers. In their purest form, judgment questions, which generally appear on civil service tests, require the candidate to use common sense in order to determine the best course of action. In these questions, the best answer is not dependent upon some particular piece of “book learning,” but rather on the ability to identify what the reasonable thing to do is. Judgment items, in their purest form, don’t often appear on the IBLCE exam, which strives to evaluate cognition and skill levels rather than just common sense.

Application questions, on the other hand, do require the test taker to have a solid understanding of “book learning.” Such questions are frequently used on the IBLCE exam to determine your ability to use factual information when identifying the best course of action. For example, application items might aim to determine how you respond to parents, solve problems, or make recommendations and referrals.

Since both judgment and application questions ultimately require you to determine what action should be taken in response to a given situation, I lump them into one category that I refer to as a “Call to Action” category. Whether you’re relying on information you read in a book or you’re just using sound reasoning principles, you will need to grapple with an item that asks you to take an action.

Earlier, we used hotels in an example of a test item that requires you to use recall and recognition skills. Here is another hotel example. This is a “call to action” item that relies on recognition and recall plus your ability to figure out what to do in a given situation.

You’re on a pleasure trip and discover that your financial resources are dwindling. In light of this information, where will you reserve a room?

a. Days Inn b. Holiday Inn c. Marriott d. Hilton

If you recall that the slogan of the Days Inn is “Spend a night. Not a fortune!” you will be likely to make your reservation at that hotel. You would have taken an action based on your recognition of the brand, as well as your ability to figure out which of the options might be the least expensive.

Strategies for Preparing for Call to Action ItemsYou can’t begin to figure out the best action in response to a test item unless you can recognize and recall information. So, you’ll need to use all of the strategies discussed in the section about preparing for recognition and recall items. In addition, there are several premises that form the basis for your decision-making and action-taking. Here are some:

VocabularyYou absolutely must know the vocabulary associated with your exam topic. If you don’t know what the words mean, how will you ever be able to determine the right answer?

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Here’s an example of an item that you could answer correctly only if you knew the definition of the key word used:

Which of the following composers wrote impressionistic music? a. Fauré b. Debussy c. Poulenc d. Foucault

If you don’t know what the word “impressionistic” means, you’re sunk. If you know anything about Impressionism, you probably can answer the item. Impressionism was a style of art and music that predominated in France in the late 19th and early 20th century, so knowing which of these men lived during that time would help. Also, if you know that Impressionism relies on rich tones and harmony rather on than structure and form, and if you are familiar with the works of Fauré and Poulenc, then you can eliminate them from your options. In addition, if you know that Impressionistic music used its lack of form to express emotion or depict scenes, you can pick the right answer. Most of this information is based on a good definition of Impressionism. Only one of the above-named men wrote music with the floaty, fragile, formless feeling of Impressionistic music. You’ve heard “Claire de Lune” a million times, and that piece epitomizes Impressionism. In fact, even if you didn’t know anything at all about Debussy except that “Claire de Lune” was one of his most famous pieces, your recall of the melody might help you to pick the right answer. If you knew that Impressionism was based in France, and you recalled the “Claire de Lune” title, you might also be able to pick out the correct answer. Finally, if you knew that Foucault was a scientist, you would be able to eliminate option (d) right off the bat!

Normal ParametersIf you don’t know what’s normal, you won’t know whether you should take an action or simply stand by and observe. For example, in order to know if a baby has achieved adequate weight gain at 1 month, 6 months or 1 year, you would need to know the weight gain that infants are expected to achieve at each of these milestones. Now don’t laugh, but I’m going to take you out of the clinical area and into the kitchen for a moment in order to demonstrate the importance of knowing normal parameters.

A recipe for cookies calls for the following: 1 cup of shortening, 1 egg, 1 cup of sugar, 2 cups of flour, 1 cup of baking powder, 1/2 teaspoon of baking soda, and 1/2 cup of nuts. What would you do if you saw this recipe?

a. Cream the sugar with the shortening and proceed. b. Beat the egg until it is lemon yellow and proceed. c. Call a friend and ask if she has tried this recipe. d. Call the cookbook publisher and verify the instructions.

Did you get the right answer? I hope so. All you’d need to know is that a cup of baking powder is totally inappropriate for a recipe that calls for 2 cups of flour. I hope I’ve made my point that knowing the normal parameters of a given topic is a critical part of successful test-taking.

Danger SignsAs an item-writer, I find that I can cook up all sorts of test items using what could loosely be called “danger signs.” These are items that require you to recognize that

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the clinical situation is worrisome and that some immediate action must be taken. Usually, the action centers on responding to or advising the parents, solving the problem, or making recommendations or referrals.

As you study, think in terms of the following: • Whendoestheconditionwarrantpromptmedicalattention? • Whatwouldbeinappropriateorharmfultorecommend? • Whatadvicetoaparentwouldgetyouinlegalhotwater?

Strategies for Correctly Answering Call to Action ItemsStrategies for correctly answering call to action items are many and varied. I usually start by identifying the topics that I don’t think I know much about. Likely as not, these are conditions or situations that I have had little or no clinical experience with. For example, it’s probably been more than 20 years since I’ve taken care of a patient with tuberculosis. If I were planning to take the exam, I’d identify this as one condition that I’d better brush up on. The first thing I’d do is to remind myself that the suffix -osis means “abnormal condition.” Then, I’d force myself to write a one-sentence definition of what tuberculosis is. (Note: Writing the description is an important study strategy. If I skip this step, I find myself thinking that I know what something means, but until I can actually put it into words, I probably don’t.) Somewhere in my description I’d write that tuberculosis is caused by bacteria (Mycobacterium tuberculosis), is acquired by breathing in infectious droplets and can be treated by long-term antibiotics. I’d jot down the medication that is used for treatment since it is not a common antibiotic, and I’d list the side effects. I’d also ask myself: Is it okay for a baby to breastfeed if the mother has this disease and is taking this odd-ball medication which I can’t even remember how to spell?

Another strategy is to make a short list of topics that you don’t feel confident about and to study those topics with a friend. You and your friend trade “war stories” of what has happened with your clients and how you have dealt with the problems in the past. Talking through real-life scenarios can be very helpful. You’ll also find that real-life scenarios are presented in nearly every chapter of my book,2 so be sure to take a look at that, too.

Graphics InterpretationItems that require the interpretation of graphics force you to apply your knowledge and comprehension skills to the analysis of non-verbal, non-textual cues. Technically, graphics can be any kind of non-text material, including bar graphs, pie charts, photos, and drawings. Most of the graphic items on the IBLCE exam will be photos, so we’ll concentrate on how to prepare for those. However, having said that, I can attest to the fact that two items on the last IBLCE exam that I took asked me to interpret a graph and a drawing. So, be prepared for whatever is thrown at you. Let’s take a quick look at Figure 1, then let’s work through the corresponding item.

Which of the following can you determine about this female from the graph in Figure 1?

a. She is underweight; teach the mother how to increase her milk supply. b. She is overweight; teach the mother about how breastfeeding may prevent

obesity. c. Her weight is appropriate for her age; applaud the mother for exclusively

breastfeeding.

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Okay, let’s talk about the photos, because I know that’s what you’ve been waiting for! As you may know, you will receive a booklet containing all of the photos (or other graphic images) that are needed to answer the exam items. The items will refer to the photos. What you may not know is how to look at the photo in a systematic way.

As you interpret each photo, focus on three basic questions. First, is something obviously wrong or pathologic in the photo? Second, what is the difference in the image from top to bottom, and from right to left? Third, what is the approximate age of the baby? These three questions, although not completely sufficient, are necessary for answering all or

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Figure 1. Weight-for-age graph of female infant.



nearly all of the photo items. The exam item below and Figure 2 demonstrate how to interpret the photo.

Which of the following would be appropriate for the baby in Figure 2? a. supplementary feeds; this baby does not look well nourished. b. complementary feeds; this baby is ready for those any day now. c. a teething toy; she is about to cut teeth any day now. d. exclusive breastfeeding with vitamin D supplementation

To choose the correct response, determine three things right off the bat. First, is something obviously wrong or pathologic in the photo? No, I doubt it. That makes it hard to see any indication for option (a). Second, what is the difference in the image from top to bottom, and from right to left? I can’t see a thing; this photo looks very symmetrical to me. Third, what is the approximate age of the baby? Hmmmmm. The baby is grasping the woman’s finger, but it is not a really tight grasp. Because the grasp reflex disappears at 3 months, I would be willing to guess that this baby is just about 3 months old. Would complementary feeding, as given in option (b) be appropriate for a 3-month old? No. Would a baby start cutting teeth at 3 months, as listed in option (c)? It’s possible, but highly unlikely. Therefore, option (d) is the best answer. Exclusive breastfeeding is best, and the AAP now recommends vitamin D supplementation for exclusively breastfed infants beginning at 2 months of age.

Pitfalls of Photo ItemsI’ve never found a book that describes the pitfalls of interpreting photo items. Dealing with those pitfalls, however, may be critical to your test success. According to IBLCE, candidates who have a hard time with the text-only items have an even tougher time with the photo items. On a personal level, I have fallen into more quicksand with the photos than with the text-only items. Oddly, I do well addressing problems of women who I see face-to-face, but somehow seeing the same problems in photos throws me off-balance. In order to master the photo items, it’s important for you to identify your own pitfalls. Here are some that I have identified.

I look at the photo and swear that nothing is wrong; I’m paralyzed.This is probably my worst pitfall. It took me a while to convince myself that it’s okay to see normal anatomy and normal babies in the exam photos. If you have this problem, try

Figure 2. Look at the photo in a systematic way.



to remind yourself that the IBLCE exam tests your understanding of normal parameters; hence, normal photos may be shown. Many of the photos that depict older children are really demonstrating growth and developmental milestones, so as likely as not, they are “normal.” Don’t become paralyzed if you can’t see anything wrong in an exam photo. Mark the item so that you can return to it if you have extra time, but by all means, answer it and move on.

There’s a little tiny speck, and I had assumed there’d be a giant-size plank.After I convinced myself that some photos actually might be normal, I suddenly started seeing too many “normal” photos. Naively, I assumed that the anomalies in the photos would be sitting right out there, front and center, saying hello to me. This is usually not the case. I had to train myself to look for tiny skin tags or tiny blisters. What I’ve learned is that I shouldn’t move on unless I’m sure that there aren’t any teeny tiny things to observe. I try to carefully examine every centimeter of a photo before declaring what I see “normal.” Little things matter.

I instantly assume that the anomaly is nothing I’ve ever seen before.After more than 20 years of looking at breasts, there are still things I’ve never seen. It’s likely that there are an infinite number of anomalies, and no one of us will see all of them before we retire. I can tell that to you here, but I find it difficult to accept it myself when taking an exam. Call it lack of confidence or call it just plain old test anxiety, but I freak out when I’m taking a test and there’s a photo of something that I’ve never seen before. I immediately feel stupid and incompetent, and it wrecks my self-confidence for the next 8 items or so. I try to remind myself that if I were sitting next to the woman in the photo, I wouldn’t freeze or feel stupid. A light would suddenly, magically go on in my head, and something would remind me of something similar; somehow, I’d figure it out. That’s what usually happens to me. An interesting side note is that after I do figure out the answer, I usually realize that I really have seen the anomaly before. I just didn’t recognize it in this context. I don’t know why I freak out on these questions, but if I am prepared for that sort of situation in advance, it can’t wreck my confidence quite so much.

I can’t figure out if I’m looking at a breast or a fist.Honestly, I know this sounds ridiculous, but I recall one photo that had me completely stumped for about 10 minutes. I couldn’t figure out if I was looking at the top half of the woman, her fist, or her infant! Her bra also looked funny to me. I finally realized that her hand was retracting the bra, and the lump I was looking at was an engorged tail of Spence. Of course, if I had been sitting next to the woman, I would have known immediately. If you find yourself in this situation, try to find a landmark. When I stared calmly at the photo, I finally recognized the hair in her underarm area. That helped me to orient myself and figure out what was what. Learn to look for obvious landmarks if you need to orient yourself.

I get grouchy because of poor photo quality.Admittedly, I’m grouchy if the photo I’m looking at in the exam booklet is not of good quality. However, I have to face the fact that there’s nothing I can do about it. I have to tell myself, “That’s tough. Now, get over it!” You’d do well to do the same for yourself. Don’t let a bad attitude about something you can’t control affect your ability to take the exam. In truth, this might not happen to you at all. Most of the photos used nowadays in the IBLCE exam are quite good.

My usual ability to distinguish between similar-looking lesions suddenly vanishes.I think it’s safe to say that you can’t get through the IBLCE examination without seeing

Don’t become paralyzed if you can’t see anything wrong in the

photo.

!



a lesion of some kind. The key is to know your lesions. There may be a million different variations, but by and large, you can boil them down to a few main types. If you don’t know the difference between a raised vesicle and a flaky dermatitis, hit the books. Make sure that you can distinguish the types of lesions from each other before you take the exam.

My eye is drawn to extraneous material in the image.Sometimes, there are things that just leap out at me. When presented with a photo showing a breast and a pump, the first thing my eye is drawn to is the pump. I have to remind myself to slow down. The pump might not be relevant at all. I need to look at everything, especially the breast. There, I might see a subtle mastitis. Include many pictures of mother and babies of varying ages in your studying. Practice identifying which items are significant and which are distracting. When you’re taking the exam, make sure you consider everything in the images, but do not allow yourself to be distracted by extraneous material there.

I make a quick and stupid decision.Sometimes, I think I know it all. That’s usually when I dive in and make a stupid decision. When I answer too quickly, I need to stop or, at least, slow down. Don’t be afraid to take a minute to review each of your responses, as time allows.

I read too far into the situation.I’m a master of looking at something and adding a slew of “well, maybe it could be...” and “of course, not all preemie babies have...” and “well, it would depend on...” comments. I have to remind myself that the photos in the exam are not asking for oddball situations. The person who submitted the photo or wrote the exam item was thinking about what generally happens. After all, this is an entry-level examination. Try to think in terms of the usual situation. As someone once said, “If you’re in Central Park and hear hoof beats, don’t go looking for zebras!”

Strategies to Prepare for Photo ItemsThere are two equally important ways to prepare for photo items. Get adequate exposure to real women with real conditions, and look at photos. The best resource for photos that I’m aware of is the Breastfeeding Atlas by Kay Hoover and Barbara Wilson Clay. There are others, of course, but if you can own only one set of photos, buy this one for the quality and variety of photos it offers.

Strategies for Correctly Answering Photo ItemsIf there are published strategies on how to answer photo items, I haven’t found them. I will say, however, that as an item-writer, I concoct my distracters by thinking of traps that people will likely fall into. Here are a few strategies that would help you overcome the traps that I would set for these types of items. (I have no idea if IBLCE will set these traps!)

Look at the photos in a systematic way.To review what was just demonstrated in the item accompanying Figure 2, it’s important to look at the photos in a systematic way.

1. Is anything in the photo obviously wrong or pathologic?2. Are there any differences in symmetry of the photo? a. Look at the image from left to right and from right to left; compare. b. Look at it from top to bottom and from bottom to top; compare. c. Look at each quadrant of the breast and compare it to the other quadrants.3. Approximately how old is the baby?



Don’t rush to choose the obvious answer.Often, it’s easy to get suckered into what seems like the obvious answer. Avoid the temptation to look at the photo, see something, and leap to answer. Take your time and really look. Look at the picture, take time to read the stem, consider all the options, and look at the photo again before you mark your answer.

Translate the photo components into words.When you look at the photo, try to describe what you see. Pretend that you are describing the photo to someone you are talking to on the phone. Jot notes in your exam booklet, so that you are forced to find words that precisely describe what’s going on in the photo, as we did with Figure 2.

As you translate the photo components into words, you are forcing yourself to really note every clue that is in the photograph. This can be especially helpful in determining the correct response for an item. Look at the item below, and the accompanying photo in Figure 3.

The mother of twins in Figure 3 says that she is worried that she “won’t have enough” to get the babies through the day today. How might you respond?

a. Explain to her that supplementation is a high likelihood in this case. b. Explain that milk transfer may be improved by using the cradle position. c. Reassure her that she has 10-100 ml of colostrum right now. d. Reassure her that she will have 850 ml by the end of the week.

Option (a) is tempting if you know that the hospital staff is often over-eager to supplement twins. But it isn’t helpful to interject your bias when answering the question. Nonetheless, keep that option in mind; it’s a possibility. Option (b) would only be appropriate if you think the baby is not positioned correctly. You might want to review this possibility. Option (c) looks like a possibility, but you’re not sure about that 10-100 number. But, you note that the woman is getting IV therapy, which suggests that she has delivered within the past 0–24 hours and, therefore, has colostrum. That, together with the observation that she is breastfeeding in the “elevator” position, is a strong clue that she has had a cesarean delivery. (Offering the lower breast and then elevating the baby on

Figure 3.



a pillow to suckle the upper breast allows the mother to avoid rolling onto her other side, which is uncomfortable after surgery.) Mothers of twins typically have 850 ml of milk per day once lactation is established, a fact which you may or may not know. But you should be able to figure out that this woman has given birth a day or two ago, and it is unlikely that she or any other mother will produce that much milk by the end of this week. Also, if she has had a cesarean delivery—which you suspect she has—there may be significant delay in establishing a full supply.

Read all options carefully.Remember that, like text-only items, photo items require you to read the stem and all of the options carefully. Keep in mind that the correct answer is literally surrounded by similar, but incorrect answers. Here’s a case where the old adage “Look before you leap.” is good advice. Consider each item seriously, and as you go through them, don’t be afraid to mark “yes,” “no” and “maybe” comments in the margin of your exam booklet.

Harness your clinical acumen.If you truly have never seen this condition before, harness your clinical acumen. Use all of the knowledge that you’ve ever amassed to somehow put the pieces together and figure it out. Even if you’ve never seen this particular anomaly, you can ask yourself: What does this remind me of? Have I ever heard about this sort of problem? What is affected by it? Have I ever read anything about this presentation of symptoms?

Types of DistractersThere are multiple distracters that could be written for each test item, but there are relatively few ways that item-writers can invent good distracters. The expertise of item-writers varies, and each has a favorite method for creating distracters, but at the end of the day, there are only a few good strategies they use. If you know the techniques used for writing distracters, you should be better able to identify and avoid them.

Outdated InformationOutdated information makes for great distracters. An effective distracter is both plausible and similar to the correct answer. That explains why outdated options are good distracters. This trick instantly allows the item-writer to create one correct option that is surrounded by similar options. The obvious way to prepare for these items is by staying current on information about the latest recommendations, equipment, and so forth. Here’s an example:

Which of the following gifts would be MOST likely to thrill your daughter? a. a 33-LP b. an 8-track tape c. a boom box d. an iPod

Unless your daughter collects antiques, the 33 records that made Elvis popular and the 8-track tapes that were state-of-the-art technology during the Beatles’ heyday aren’t going to thrill her. If she asked for a boom box a couple of years ago, her wishes have probably changed. The hot thing now is the iPod. By the time that you see this learning package in print, it’s possible that the iPod will have been replaced by some other newfangled thing.

My point is that outdated information lures you into picking the wrong answer. After all, it was correct – at one time. Similar to the example above, if you haven’t kept up with what’s going on in the field of lactation, you’ll be lured by the wrong answer.

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Outdated information

makes for great

distracters.

!



“Echo” OptionsIf two options are opposite, it’s highly likely that one of them of them is the right answer. Here’s an example:

Which of the following would correctly describe the problem seen in this photo?

a. The shield is too large. b. The shield is too small. c. The shield was not applied correctly. d. The shield is not necessary for this nipple.

To answer this, it would be best if you actually know the information. If you don’t, try to realize that the item writer probably used one of the size problems (too large or too small) because one is the right answer, and the opposite one is the wrong answer. Stated otherwise, something can’t be both too small and too large, so one of the options is definitely a distracter.

Sounds Like...Distracters that sound like the correct answer can lure you into picking an option that isn’t correct. Again, this demonstrates how good distracters tend to be very similar to the real answer. Here is an example of a test item in which the distracters sound like the correct option:

Which of the following would be prescribed for a mother who was suffering from depression?

a. Celebrex b. Cerebyx c. Celexa

The obvious way to deal with these is to know your material. You should have studied pathological conditions that may affect women of childbearing age and medications that are indicated for those conditions. If you know about depression and medication prescribed for it, the other two names won’t be able to fool you. Otherwise, it is likely that you’ll fall prey to one of the distracters that sound like the correct answer.

Looks Like...Distracters that look like the correct answers are also a killer if you have almost but not quite mastered the material. Here’s an example of an item in which the distracters look similar:

Which of the following is normally present in the fetus, but not normal in an infant 3 or 4 days old?

a. foramen magnum b. foramen ovale c. mastoid fontanelle

Did you have a little trouble with that? A “foramen” is a passage. “Magnum” means large. The spinal cord passes through a large orifice in the skull, and meets up with the brain. Therefore, since everyone needs brains and spinal cords connected throughout life, you know this structure will remain throughout both intrauterine and extrauterine life. The fontanelles are open and do not close for several months after birth. The foramen ovale is an opening that is present for fetal circulation, but it closes after delivery. If you didn’t know your material, you’d probably have difficulty figuring that out.

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Tackling the IBLCE Examination

After you’ve prepared and practiced, you need to tackle the exam. Most times, it seems like a formidable opponent. It looks bigger, stronger and faster than you. But it’s not. It’s just paper with some ink on it. Just like this paper. So, get over it. You’re bigger, stronger, faster, and much smarter than some little old pieces of paper. You can pass the test!

Your exam success is really dependent upon what you do in three situations. The first situation is when you know the answer. This is what will happen most often; if you simply mark the right answer, you’re on your way to a passing score. The second situation is when you feel a little uncertain about the answer. With a few well thought out strategies, you can usually select the right answer. The third situation is when you’re completely stumped. There, you need to do some heavy-duty lifting to increase your chances of answering correctly.

When You Know the AnswerRead carefully. Take notes. Answer the easy items first. Note qualifiers carefully. After you read the stem, figure out the answer in a logical way. Then, trust yourself and don’t change your answer!

Read Carefully; Write NotesIt’s permissible to write in the IBLCE exam booklet, so get out your pen and start underlining and marking. Underline any qualifiers in the stem or the options. (See below for more discussion of this.) Cross out any options that you know are incorrect. Jot down words that help you think about the item. Circle the items that you need to come back to or have doubts about. Scribble diagrams or drawings to help you think through concepts. Make a note if you want to come back and write a comment about the item. If you haven’t written all over the items and the margins, you are probably not thinking everything over as carefully as you should.

Answer the Easy Items FirstAnswering the easy items first accomplishes a couple of important things. First, it helps you to get them out of the way so that you can spend more time on the more difficult items. Second, it boosts your morale; once you’ve answered several items in a row confidently, you’ll feel like you’re on a trajectory to pass the exam.

Note the QualifiersQualifiers can occur in the item’s stem of or its options. Any time that an item has a qualifier in either part, you can bet that it is critical to finding the correct response.

Here are some qualifiers that typically occur in the stem: most, least, except, first, last, only, primarily, and best. There are probably others, but these are the ones that I’ve seen most often. Remember that a qualifier in the stem is critical for picking the right answer.

IBLCE has identified that the construction of “least likely” in the stem is a frequent stumbling block for people taking the exam. Allow me to offer a stern warning about this construction: Be very careful! Only moments after reading that the “least likely” qualifier is a common stumbling block in the IBLCE exam, I took IBLCE’s mock exam. When I corrected my responses, I noted that I had incorrectly answered every single item that had a “least likely” qualifier! I think the reason that such questions throw me is that, in my real clinical practice, I never think about the least likely thing to happen or the least helpful action

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to be taken. I think in terms of the likely or most likely situations. I think in terms of what would be helpful or most helpful to my patients. So, I know this least-likely construction is my severe weakness, and I know I really need to work on it. You should carefully analyze your own test-taking to see if qualifiers in the stem pose a particular problem for you, too. In any case, these items benefit from extra time and review, as available.

Qualifiers in the Options Favor options that use qualifying terms such as “often” and “most.” Such words are generally used in order to provide longer, more detailed explanations that are better responses than less specific options. When qualifiers appear in options (e.g., an LGA baby born yesterday or a mother who has had history of xyz disease), they are generally included to make the right answer more right.

Be wary of options that use specific determiners or absolute words, such as “always” or “every.” Try substituting a qualified word for the absolute one (e.g., “frequently” for “always” or “typical” for “every”) to see if you can eliminate those options.

Stick With Your First AnswerResearch shows that, in general, the first answer you write down is usually the correct one. So, follow your gut; you are probably right. Do not second-guess yourself. Do not change your answer unless you are absolutely certain that you made a mistake. I can’t count how many times I have chosen the right answer, then second-guessed myself and erased it to select an incorrect response instead. This doesn’t just happen to me. Numerous times, I’ve warned participants of Marie Biancuzzo’s Lactation Exam Review course to stick with their first answers when taking the mock exam. Then, I administer the exam. When we have looked at the changes that people made to their first responses, we found that, of those who wrote an answer and later changed it, more than 50% had written the correct answer the first time. Trust me on this one. I’ve read it in books, and I have plenty of empirical information to back up my recommendation: Don’t change your answer unless you are sure you made a mistake.

When You Feel A Little UncertainIf you’re like me, there are plenty of test situations that make you feel uncertain. For example, you might find that you know some but not all of the information included in the stem. Or, perhaps you know that two of the options are incorrect, but you’re debating with yourself between the other two. In these and similar cases, you need to bolster your powers of recall and deal effectively with distracters.

Bolster Your Powers of RecallThere are a couple of ways to effectively bolster your powers of recall. The first is to use visualization techniques for the stem and the response options. The second is to use etymology, prefixes, suffixes and roots as clues.

VisualizeWhen possible, I find it helpful to visualize real-life situations as I’m reading text-only questions. For example, I once had to answer a question about a “long” umbilical cord. I didn’t know how many inches a “long” umbilical cord would be. However, I did remember handling one that stretched from my left hand to my right hand when both of my arms were fully extended. Using that imagery, I was able to guess at the length of a “long” umbilical cord.

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!I had

incorrectly answered

every single item that

had a “least likely”

qualifier!

Of those who wrote an

answer and later changed it, more than

50% had written the

correct answer the first time.

!



Use Etymology, Prefixes, Suffixes, and RootsI’m not the smartest person in the world, nor am I the best test-taker. What has saved my hide hundreds of times is knowing the etymology, prefixes, suffixes, and roots of words. Take a look at this example from Linda Smith’s book3:

Carbohydrates in human milk include all of the following except a. lactose. b. oligosaccharides. c. sucrose. d. gluconjugates.

If you didn’t know anything at all about any of the four options, you could still correctly answer this item if you knew the suffixes and remembered one main fact from your biology course 20 years ago. If you knew that –ide means sugar and that –ose means starch, you’d only need to remember that sugars and starches are both carbohydrates. Given this bit of knowledge, you could deduce that responses (a), (b) and (c) are carbohydrates, and you could select the correct response, (d).

Deal with DistractersForgive me if you’re tired of hearing me say this, but distracters are there to distract you! Learn to deal with them; learn how to not get distracted by them.

First, Cover the OptionsSometimes, just covering up the options can help you avoid falling into the trap of a good distracter. Otherwise, you may read something that distracts you from what you know to be correct.

Eliminate Wrong Answers and Treat as True/FalseEliminating the wrong answer is best accomplished by crossing off the obviously wrong responses in your test booklet. Most people can eliminate two of four options right off the bat. If you can eliminate them, cross them off.

Although the IBLCE exam is a multiple-choice test, it can be helpful to treat the options as true-false situations when you’re unsure of the correct answer. To do this, first read the stem of the item. Then, next to each option in the test booklet, write, “true” if you believe it’s true and “false” if you think it’s false. Write a question mark if you don’t know. Try it with this simple example:

The IBLCE is a. a for-profit organization. b. an offshoot of La Leche League. c. headquartered in Fairfax, VA. d. administering an exam in June.

You probably knew right off the bat that the IBLCE is not a for-profit organization. So you could mark that as false. You might have marked options (b) and (c) with a question mark. That brings you up to option (d), which, hopefully, you marked false. Can you see how treating this example as a true/false item helped you to eliminate two of the four options right away? By the way, the correct response is (b). According to the LLLI site, “The International Board of Lactation Consultant Examiners (IBLCE) is a non-profit corporation established in 1985 by La Leche League International to develop and

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administer professional certification for lactation consultants. The IBLCE is a not-for-profit organization, headquartered at 7309 Arlington Boulevard, Falls Church, VA. The exam is given every July.”

Be Suspicious of Unfamiliar OptionsOptions that aren’t familiar to you should immediately rouse your suspicions. Very possibly, they are look-like or sound-like distracters. Sometimes these are real words; other times, they are invented by the item-writers! As a general rule, don’t pick an option if you don’t know what the word means. As an item-writer, I love making up words to use for distracters. I’m always amused at how many people pick an option I’ve invented when there is no such thing!

Compare Options for DifferencesIf two options seem correct, compare them for differences. Then, refer to the stem to figure out your best answer. Here is an example of options that may seem correct, but are found to be different under careful examination:

For the first 6 months of life, the American Academy of Pediatrics recommends which of the following?

a. full breastfeeding b. exclusive breastfeeding c. partial breastfeeding d. supplemented breastfeeding

At first glance, you might eliminate options (c) and (d) as wrong. Then, you might think about picking “full breastfeeding,” because full breastfeeding because it means that the infant is fully nourished on breast milk. However, the fully breastfed infant may also receive one of several non-nourishing fluids, such as water or tea. The exclusively breastfed infant, however, receives absolutely no foods or fluids other than human milk; this is what the AAP recommends. Thus, option (b) is the correct answer.

When You Are Completely StumpedWhen you are completely stumped, you should guess! Now, I mean you should guess when you are you are completely, totally, 101% stumped. (For me, this is when I encounter an item that causes me to say to myself, “I don’t even understand the question, so I cannot pick the right answer!”) Not to worry. All you need to do is make a good guess. Any savvy test-taker can make a good guess.

Guess! You Might Be Right!I started writing test items in 1985. I have probably written hundreds of items since then. Although I’ve had substantial training in item-writing, I cannot tell you that I’m a master of it. What I can tell you is that writing an item with superb distracters is a work of art. Few can do it so well that they never write a dumb distracter. That is to your advantage. Dumb distracters are great for test-takers. If you truly don’t know the answer and need to guess, a poorly written distracter will be your salvation, as it helps you to eliminate at least one option that is too foolish to be right.

25

As an item-writer, I

love making up words to use for

distracters.

!



Okay, Your Turn!

When you get your Candidate Guide from the IBLCE or download it from the web, be sure to take a look at the sample items. These are real items from past examinations; therefore, they are representative of the style and the difficulty of the exam you will face.

In Appendix A, you will find some practice items that I have created. Understand that I do not write items for the IBLCE exam, and I have no knowledge of the specific items that will be asked. Most of the items in Appendix A are reprinted from the syllabus of Marie Biancuzzo’s Lactation Exam Review course, and many demonstrate the concepts that I’ve talked about in this learning package. In Appendix B, I’ve provided the answers, a brief analysis of the pitfalls that you might encounter in answering the items and study strategies to help you with similar items.

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Summary

Your success in passing the IBLCE starts with mastering the mundane. Feeling informed and confident of the site details and minimizing any last-minute snags will help you to approach the exam feeling reasonably unhurried and relaxed. Preparing for a comprehensive examination is always a daunting task; studying for the IBLCE exam is no exception. However, by knowing what to expect on the exam and using effective study strategies, you’ll be able to prepare yourself better. Recognizing your own weaknesses, especially with photo and “least likely” items, will enable you to better prepare for and eventually take the exam. Understanding how exam items are constructed will help you to more easily dismiss the distracters and choose the right answers. Whether you feel very sure, a little uncertain or completely stumped, you can maximize your chances for successfully answering any item by using the strategies discussed in this learning package. Good luck!

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References

1. Meyers JN. The Secrets of Taking Any Test: Learn the Techniques Successful Test-Takers Know. 2nd ed. New York, NY: LearningExpress; 2000.

2. Biancuzzo M. Breastfeeding the Newborn: Clinical Strategies for Nurses. St. Louis, MO: Mosby; 2003.

3. Smith L. Comprehensive Lactation Consultant Exam Review. Sudbury, MA: Jones & Bartlett; 2001.

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Appendix A: Practice Questions

The following questions are reprinted from Marie Biancuzzo’s Lactation Exam Review, © 2006. All rights reserved.

1. All of the following accurately describe oxytocin EXCEPT a. it is secreted by the anterior pituitary. b. it is secreted by the posterior pituitary. c. it is the primary hormone that regulates milk ejection. d. it causes the epithelial cells of the alveoli to contract.

2. The alveolus contains two types of cells; these are the a. myoepithelial cells and the secretory cells. b. myoepithelial cells and the squamous cells. c. secretory cells and the squamous cells. d. squamous cells and the stem cells.

3. Which of the following will suppress the release of oxytocin? a. infant suckling the breast. b. hearing the infant cry. c. ice on the nipples. d. consuming a warm drink.

4. The sucking reflex could be correctly described as a. elicited by tactile or chemical stimulation of the palate. b. elicited by tactile or chemical stimulation of the tongue. c. present beginning around 34th week of gestation. d. disappearing around 6 months of life.

5. Negative pressure exerted by the infant’s mouth on the nipple/areola primarily a. draws milk out of the breasts. b. reduces the resistance of the sucking fat pads. c. holds the nipple/areola in place.

6. During the first 20 minutes of suckling, you could say that serum prolactin levels a. somewhat decrease from baseline. b. more than double from baseline. c. more than triple from baseline.

7. From day 4 to day 20, the grams of lactose in human milk a. increase, which increases milk supply; concentration is about the same. b. increase, which increases milk supply; concentration also increases. c. increase, which increases milk supply; concentration decreases. d. decrease, which increases milk supply; concentration is about the same.

8. A more acid gut environment would a. inhibit the growth of normal flora. b inhibit the growth of acidophilus. c. promote the growth of lactobacilli. d. promote the growth of clostridia.

9. Lysozyme is an a. ion. b. enzyme. c. interferon. d. immunoglobulin. continued on the next page



Appendix A: Practice Questions (continued)

10. As concentrations of lactose increase, a. milk volume increases and sodium concentrations decrease. b. milk volume increases and sodium concentrations increase. c. milk volume decreases and chloride levels decrease. d. milk volume decreases and chloride levels increase.

11. Long-chain polyunsaturated fatty acids are essential for a. soft, nonmalodorus stools. b. retinal and neural tissue development. c. glucose synthesis and stabilization. d. bilirubin transport and excretion.

12. Bioactive factors in human milk include all EXCEPT a. glucoconjugates. b. nucleotides. c. triglycerides. d. cytokines.

13. Which two deficiencies would be most likely to occur in a lactating woman? a. calcium and zinc b. calcium and phosphorus c. magnesium and zinc d. potassium and zinc

14. A mother with CMV gave birth to a baby who weighed 1427 grams at birth. She wants to know if it is okay to breastfeed. Which of the following would be your BEST response?

a. Reassure her that breastfeeding is not contraindicated for CMV. b. Talk with her and her doctor about some possible precautions. c. Initiate breastfeeding only after the infant has had the HBIG vaccine. d. Gently inform her that breastfeeding is strictly contraindicated in this case.

15. The natural-killer (NK) cells are a. non-specific white cells to fight disease. b. specific white cells that fight disease. c. red cells that destroy disease. d. red cells that prevent disease.

16. To help a mother who has Hepatitis B, you should a. teach her how to prepare formula for her infant. b. make sure her infant has been given the HBIG. c. make sure her prescribed antibiotic is safe during breastfeeding. d. tell her to freeze her milk for 72 hours before giving it.

17. When choosing a breast shell for a woman with flat nipples, you would choose the style with which of the following characteristics?

a. a smaller hole. b. a larger hole. c. a cotton insert.

continued on the next page



18. You might describe an obturator as a. used for newborns with Down syndrome. b. used for older infants with autism. c. a semi-soft prosthesis for a cleft palate. d. a semi-soft prosthesis used after a mastectomy.

19. You are watching 4-week old Timmy while he suckles his mother’s breasts. Which of these observations would require further follow-up?

a. His tongue is extended over his lower alveolar ridge. b. Long, slow rhythmic sucks are preceded by several short 1-second sucks. c. He takes about 5-8 sucks and then he swallows. d. He continues to suck until he is completely asleep.

20. A mother reports that she has an itching, burning feeling in her breasts especially after she finishes breastfeeding Tony. The MOST important advice you could give her is that she should

a. give her breasts a rest over the weekend, and continue breastfeeding after she has had a chance to heal.

b. avoid the new soap that she says she purchased; this is a likely cause of her discomfort.

c. make an appointment to see her health care provider as soon as possible. d. try some over-the-counter Neosporin ointment and call her health care provider

if it doesn’t clear up within a day or two.

21. A mother of a 4-month old calls and says that she and her baby are enjoying great health, and she is delighted that everything has gone so well for them. She notices, however, that some milk that she stored in her refrigerator yesterday has a soapy, cloudy appearance. She wants to know what to do. You should tell her that

a. the milk is fine; she can warm it and swirl it gently before giving it to the baby. b. the milk is spoiled; she should discard it and call her doctor and hope that she

can get started on antibiotics right away. c. the milk is questionable; it needs to be sent for a laboratory analysis before any

recommendation is made.

22. A woman reports that she has caught a cold, and she feels miserable. She says that she is already using the products listed below. Which of these is MOST likely to reduce her milk supply?

a. Tylenol. b. Sudafed. c. Mentholyptus cough drops. d. Afrin nasal spray.

23. Your client and her infant have had a difficult time getting breastfeeding to go smoothly. The mother finally confesses that when he arches his back and pulls away from her, she wants to hit him. Which of the following would you do?

a. Document this feeling and past experience with the client that she is gentle and would never harm the baby.

b. Document her exact quote, and notify the state authorities. c. Document her exact quote, and notify her physician. d. Remember this, and document it if she says it again. continued on the next page





24. Pat is the mother of two 32-month-old twins and reports that one of her twins is starting to use 3-word sentences. You should respond by telling her that

a. you’re delighted that he has reached this age-appropriate milestone. b. the other twin will soon do the same behavior. c. it is not uncommon for twins to have a developmental lag. d. she really needs to see a developmental pediatrician.

25. A colleague of yours says that the Pump In Style® pump is being used by several clients in her clinic. She wants to know if this is okay. You remind her that

a. the FDA says that this is okay, as long as the mother use their own accessory kits. b. the manufacturer advertises this as a single-user product. c. the Durable Medical Equipment Act prohibits sharing of any pumps, regardless

of design or brand. d. there are no official standards on whether this is okay or not.



Appendix B: Key for Practice Questions

Number Answer Answers in Biancuzzo Explanation and Test Tips

1. A Page 55, 64 Requires knowledge of hormones. Anatomy & Physiology.

2 A Page 59, Fig. 4-5 Requires knowledge of cellular structure of the alveolus. Anatomy & Physiology.

3 C Page 55-56 Requires understanding of the factors that affect the hormonal response. Anatomy & Physiology.

4 A Page 156 Requires understanding of suckling as a reflex. Anatomy & Physiology.

5 C Page 158 Requires understanding of how the suckling is related to milk transfer. Anatomy & Physiology.

6 B Page 57, Fig 4-2 and text Requires an understanding of how infant suckling affects hormonal levels. Anatomy & Physiology.

7 A Page 69 Requires an understanding of how lactose is related to milk volume. Biochemistry.

8 C Page 70 Requires and understanding of the basic newborn gut physiology. Anatomy & Physiology.

9 B Page 71 10 A Page 63, Fig 4-9 Requires knowledge of how volume is related to sodium and

chloride. Biochemistry. 11 B Page 67 Requires knowledge of the function of PUFAs.

Biochemistry. 12 C Page 71 Requires knowledge of all of the terms listed. Biochemistry. 13 A Page 84 Requires knowledge of which nutrients a woman would be

at risk for. Biochemistry/nutrition. 14 B Page 358 Transmission of cytomegalovirus via the mother’s milk is a

concern for the preterm infant. Pathology. 15 A Page 71 Requires knowledge of these leukocytes. Immunology. 16 B Page 359 Requires an understanding of implications for transfer of

Hepatitis B via infected mother’s milk. Pathology. 17 A Page 332 Requires a basic understanding of the two different designs

of shells. Technologies. 18 C Page 324 Requires knowledge of medical management for infant with

a cleft. Pathology. 19 C Requires understanding of the normal suckling sequence.

Techniques. 20 C Requires recognition of the typical symptoms of candidiasis.

Pathology. 21 A Requires an understanding of components of milk that are

changed by temperature. Biochemistry. 22 B Requires a basic understanding of the side-effects of

Sudafed, i.e., drying up secretions. Pharmacology. 23 B Requires an understanding of what we are obligated to do in

terms of suspected child abuse. Legal/Ethical. 24 C Requires an understanding that children say 3-word

sentences by about 28 months, and one twin does not necessarily reach the same developmental milestones at the same time as the other twin.

25 B Requires an understanding of what the standards are for single-user pumps.



Appendix C: IBLCE Exam Blueprint

Topic Number of Items

Maternal and infant anatomy 19–33

Maternal and infant normal physiology and endocrinology 19–33

Maternal and infant normal nutrition and biochemistry 10–16 •TheBiochemistryofHumanMilk •NutritionforLactatingWomen •GuidelinesforInfantBreastfeeding •ArtificialMilk

Maternal and infant immunology and infectious disease 10–16 •AllergenicProtection&DefenseAgentsandSystemsin

Human Milk •ProtectionAgainstChronicDisease

Maternal and infant pathology 19–33

Maternal and infant pharmacology and toxicology 10–16

Psychology, sociology, and anthropology 10–16

Growth parameters and developmental milestones 10–16

Interpretation of Research 4–8

Ethical and Legal Issues 4–8

Breastfeeding Equipment and Technology 10–16

Techniques 19–33

Public Health & Advocacy 4–8

Chronological Period Number of Questions

Preconception 2–7

Prenatal 9–17

Labor/birth 9–17

Prematurity 9–17

1–2 days 19–31

3–14 days 19–31

15–28 days 19–31

1–3 months 9–17

4–6 months 9–17

7–12 months 2–7

Beyond 12 months 2–7

General Principles 40–53



Appendix D: Typical Agenda for Exam Day

Registration: Check start time!

Morning Session: 9:00 AM to 12:00 PM 100 text-only items (all multiple coice)

Lunch: 12:00 PM to 1:00 pm Lunch (on your own)

Afternoon Session: 1:00 PM to 4:00 pm 75 photo items

25 text-only items (all multiple coice)

Appendix E: Books that Help You to Prepare for Exams

Brainerd LW & Winegardner R. 10 Secrets to Acing Any High School Test. (2nd ed.). New York, NY: LearningExpress, 2003. ISBN: 157685437X, 180 p., $14.95. Topics covered include managing time, proper preparation, learning styles and preventing

test stress.

Evans, Mike. Make Exams Easy: The Things You Need To Know. Oxford, England: How to Books Ltd, 2004. ISBN: 1857036212, 64 p., $8.75. Practical advice for test takers from junior high through senior citizen level.

Fry, Ronald W. "Ace" Any Test. (Ron Fryís How to Study Program Series, 4th ed.). New York, NY: LearningExpress, 2000. ISBN: 1564144607, 128 p., $15.95. This guide walks students through successful test preparation, including reading for

maximum retention, researching the teacher’s test-giving history, and “psyching up” for test day.

Meyers JN. The Secrets of Taking any Test: Learn the Techniques Successful Test-Takers Know (2nd ed.). New York, NY: LearningExpress, 2000. ISBN: 1576853071, 250 p., $14.95. Designed specifically for adults who need work related training.

Nugent PM & Vitale BA. Test Success: Test-Taking Techniques for Beginning Nursing Students. Philadelphia, PA: FA Davis, 2000. ISBN: 0803605242, 359 p., $26.95. Text to aid the nursing student in mastering a wide range of testing formats, reducing

anxiety, developing confidence and passing fundamentals.

Nugent PM & Vitale BA. Fundamentals Success: A Course Review Applying Critical Thinking to Test Taking. Philadelphia, PA: FA Davis, 2003. ISBN: 0803610564, 364 p., $29.95. This study guide offers assistance applying critical thinking and problem-solving skills to

multiple-choice questions. Written for nursing students.

Rozakis L. Test Taking Strategies and Study Skills for the Utterly Confused. New York, NY: McGraw-Hill, 2002. ISBN: 0071399232, 276 p., $16.95. This skill-building resource shows students, career changers, and business professionals how

to take tests with optimal confidence and success.

Springhouse Corporation. Studying and Test Taking Made Incredibly Easy! (Made Incredibly Easy Series). Baltimore, MD: Lippincott Williams & Wilkins, 1999. ISBN: 1582550190, 239 p., $32.95. Exam review includes self-assessment checklists, strategies for improving memorization and

comprehension, guidance on taking every type of test, and more.



Post-Test

Instructions: Answer all ten of the following questions. You may write on this sheet as much as you like, but to earn your continuing education credits, you must submit your answers on the answer sheet provided on page 38.

1. Using a mnemonic is helpful for: a. remembering a fundamental principle. b. remembering a list of things. c. estimating a mathematical calculation. d. eliminating a non-plausible answer.

2. An instructor is presenting a lactation exam review course. She realizes that no one noticed that the right breast showed veining and the left breast did not. Which of the following should she recommend for course participants?

a. A better familiarity with the changes of pregnancy. b. A better understanding of the effects of veining. c. Looking at the photo for superior-inferior symmetry. d. Looking at the photo for left-to-right symmetry.

3. You are having difficulty remembering which of the cranial nerves is primarily responsible for swallowing. Which of the following strategies might be MOST helpful for mastering the information?

a. Trading war stories with a colleague about a baby who could not swallow. b. Having a clear command of prefixes and suffixes. c. Using some form of distributed practice. d. Using kinesthetic clues for better recall.

4. An instructor notices that on her mock exam, participants frequently choose “massage the area proximal to the plugged duct” rather than the correct option, “massage the area distal to the plugged duct.” The MOST likely reason that participants miss this question is that they do not understand:

a. effective management of plugged ducts. b. how to achieve proper breast massage. c. the meaning of the words in the options. d. the basic principles of lactation management.

5. Which of the following would be LEAST LIKELY to help you on the IBLCE exam? a. jotting a diagram next to the item in the test booklet. b. leaving an item unanswered to avoid a penalty for a wrong answer. c. crossing out options in the test booklet that are incorrect or questionable. d. randomly picking an answer and darkening the circle on the answer sheet.

6. After writing the entire exam, you review all of your answers. You feel that you might have made a mistake answering #42. You have answered #40, #41, #42, and #43 with option A. You should change your answer ONLY if you

a. have second thoughts about your initial response. b. think there are too many “A” responses. c. are absolutely certain your first answer was wrong.

continued on the next page



Post-Test (continued)

7. You read the stem and the four options of a test item. You are really struggling to select the correct answer. Which of the following strategies will NOT be helpful?

a. Selecting option A because has a qualifier in the stem. b. Selecting option B because it reminds you of a similar situation you’ve seen in

clinical practice. c. Selecting option C because it seems within what you guess might be normal

parameters. d. Selecting option D because it’s the only option with a word you don’t recognize.

8. While taking the IBLCE exam, you find yourself staring at a photo of a child who is breastfeeding while standing. The mother looks comfortable. The child’s latch looks good. You can’t figure out what’s wrong in the photo. You finally conclude that:

a. the photo quality makes it impossible for your to figure out what’s wrong, so you should simply guess.

b. you should write a comment on your critique form that it’s impossible to determine what’s wrong in this photo.

c. the correct answer must have something to do with the standing position. d. you should trust your gut, assume that nothing is wrong, and pick the option

that reflects that.

9. Excellent distracters include all of the following EXCEPT those that are: a. written with outdated information. b. chosen by the vast majority of exam writers. c. very similar to but different from the correct response. d. implausible in any situation.

10. You decide to memorize the 206 bones of the body. The MOST effective strategy would be to:

a. order them alphabetically, and use flash cards to memorize each. b. write them all down again and again until you memorize them. c. say them out loud again and again until you memorize them. d. memorize one body part or cavity (the hand, the chest, etc.) at a time.



Post Test Answer Sheet

Answers to Post-Test Statement from Participant

1. 1 2 3 4

2. 1 2 3 4

3. 1 2 3 4

4. 1 2 3 4

5. 1 2 3 4

6. 1 2 3

7. 1 2 3 4

8. 1 2 3 4

9. 1 2 3 4

10 1 2 3 4

I have:

o Completed the 10-question true/false pre-test viii.

o Read the self-learning package.

o Completed the practice questions.

o *Completed the open-book post-test on page 36 without assistance from others.

o Written answers to the post-test in the spaces to the left.

o Completed and returned the evaluation of the package.

o Understood that payment is for the opportunity to earn credits and is not refunded if I do not pass the post-test.

o Enclosed my payment.

By signing below, I declare that the above statements are true.

Signed _______________________________________________________________________________________

If IBCLC, date of certification: ____________________________________________________________________

We will not grade your post-test until you mail or fax all of the following materials: •Packageevaluation •Thissheet,completedandsigned •Paymentfor$25.00(Check,Visa,MasterCard,AmericanExpressorDiscover)to:

Breastfeeding Outlook POBox387,HerndonVA20172-0387 Fax:703-787-9895

Name _______________________________________Organization ______________________________________

Address ______________________________________________________________________________________

City, State, ZIP ________________________________________________________________________________

Phone ___________________________________________E-mail ______________________________________

Continuing education fee of $25.00

Payment method

o Check enclosed

o Visa o MasterCard o American Express o Discover

Name on card _________________________________________________________________________________

Card Number # _______________________________________________________________Exp date __________

Signature _____________________________________________________________________________________

See FAQ on page iv for common questions.

Reminder: This self-learning package does NOT award CERPs for lactation consultants.



COMPLETE BOTH THIS AND THE FOLLOWING PAGE and mail or fax to:Breastfeeding Outlook • P.O. Box 387 * Herndon, VA 20172 • Fax: 703-787-9895

YOU MAY PHOTOCOPY THIS PAGE.

Package Evaluation

Our aim is to provide high-quality learning resources for health care professionals . We need your help! Now that you have used this resource, please take a few moments to let us know what you think!

Excellent Good Fair Poor

1. Extent to which objectives were related to the overall goal e g f P

2. The extent to which the package met the stated objectives:

a Plan how to get to the exam site and avoid last-minute snags E g f P

b. Describe general study strategies for preparing for a comprehensive exam. E g f P

c. Describe how to effectively prepare for items on the IBLCE exam. E g f P

d. Describe how to correctly select correct options when taking the IBLCE exam. e g f p

e. Given one of the 4 types of distracters, use effective strategies for selecting the right answer. e g f p

f. Recognize and avoid the pitfalls of photo items e g f p

g. Describe specific techniques for selecting correct responses when you know the material, when you are uncertain, and when you are completely stumped

e g f p

3. Extent to which content increased/updated my knowledge of the content presented: e g f p

4. Package was clear and easily understood. e g f p

5. Quality of resources in Appendix: e g f p

6. Theoretical information given was relevant to exam situations. e g f p

7. Effectiveness of the package:

a. provided helpful illustrations to explain text e g f p

b. stimulated critical thinking e g f p

c. integrated scientific data with real-life clinical situations e g f p

8. Rate the following:

a. extent to which my personal objectives were met e g f p

b. satisfaction with ordering and shipping e g f p

c. clarity of instructions for completing the package e g f p

9. Overall, this self-learning package was: e g f p

10. Professional Credentials (fill in all that apply)

. RN . IBCLC . PNP

. RD . CLC . FACCE or other childbirth certification

. MD . CLE . Other ___________________________________

. CNM . CBE



YOU MAY PHOTOCOPY THIS PAGE.

COMPLETE BOTH THIS AND THE PREVIOUS PAGE and mail or fax to:Breastfeeding Outlook • P.O. Box 387 * Herndon, VA 20172 • Fax: 703-787-9895

Package Evaluation (continued)

11. Fill in ALL of the reasons you purchased this package. . Needed the continuing education credits [CPEs, CEUs, contact hours] . Wanted to update and increase my professional knowledge. . Unable to attend classes/conferences in other locations. . Price was right. . Could do the work on my own time. . Other _______________________________________________________________________________12. Fill in the ONE main reason you purchased this package. . Needed the continuing education credits [CPEs, CEUs, contact hours] . Wanted to update and increase my professional knowledge. . Unable to attend classes/conferences in other locations. . Price was right. . Could do the work on my own time. . Other _______________________________________________________________________________ .

13. How did you find out about this learning package? . Course or conference display. . Ad on the worldwide web. . Ad in Journal of Human Lactation. . Flyer in the mail. . Heard from friend or colleague. . Other ______________________________________________________________________________

14. Would you recommend this package to a colleague? . Yes . No, because __________________________________________________________________________

15. What suggestions do you have for improving this package?

16. Would you buy a self-learning package again? . Yes . No, because __________________________________________________________________________

17. What other topic(s) would you recommend for future self-learning packages?

18. Other comments?

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