CBS Treatment Planning & Management 2 — Questions and Answers
Question 1: A mother reports severe nipple pain described as burning and shooting pain between feedings. What condition should the CBS suspect first?
- Raynaud's phenomenon
- Candida (thrush) infection (Correct answer)
- Incorrect latch
- Mastitis
Correct answer: Candida (thrush) infection
Burning, shooting nipple pain between feedings is a classic presentation of Candida infection affecting the breast and nipple.
Question 2: When planning care for a mother with a history of breast reduction surgery, which concern is MOST critical to address early?
- Nipple hypersensitivity
- Milk supply adequacy (Correct answer)
- Scar tissue tenderness
- Engorgement risk
Correct answer: Milk supply adequacy
Breast reduction surgery can sever milk ducts and nerves, making milk supply adequacy the primary concern requiring early assessment and supplementation planning.
Question 3: A CBS is developing a plan for a mother of twins. Which feeding strategy is generally recommended to maintain supply for two infants?
- Alternate breasts per infant per feeding session
- Feed both infants simultaneously at each feeding (Correct answer)
- Pump after every feeding to increase supply
- Supplement one twin with formula while breastfeeding the other
Correct answer: Feed both infants simultaneously at each feeding
Simultaneous tandem feeding is recommended for twins as it saves time, stimulates both breasts concurrently, and helps establish and maintain adequate milk supply.
Question 4: A mother with flat nipples is struggling to achieve latch. Which intervention should the CBS recommend as a FIRST step before each feeding?
- Use a nipple shield immediately
- Evert the nipple manually or with a breast pump briefly before feeding (Correct answer)
- Introduce bottle feeding temporarily
- Apply lanolin cream to soften the nipple
Correct answer: Evert the nipple manually or with a breast pump briefly before feeding
Briefly evert the nipple manually or with a breast pump before latching helps flat nipples protrude enough for the infant to grasp effectively.
Question 5: In developing a plan for a mother with insufficient glandular tissue (IGT), which statement about supplementation is MOST accurate?
- Supplementation should be withheld to stimulate demand
- Donor milk or formula supplementation at the breast preserves breastfeeding while ensuring adequate infant nutrition (Correct answer)
- Supplementation at the breast is contraindicated with IGT
- Pumping alone is sufficient to increase glandular tissue over time
Correct answer: Donor milk or formula supplementation at the breast preserves breastfeeding while ensuring adequate infant nutrition
With IGT, supplementation at the breast using a supplemental nursing system (SNS) ensures the infant receives adequate nutrition while still stimulating the breast.
Question 6: A mother at 5 days postpartum has not experienced lactogenesis II (milk coming in). After ruling out retained placenta, which intervention is MOST appropriate?
- Advise the mother to rest and wait another 48 hours
- Encourage frequent skin-to-skin contact and increase feeding or pumping frequency immediately (Correct answer)
- Prescribe a galactagogue as the first line of treatment
- Switch to exclusive pumping
Correct answer: Encourage frequent skin-to-skin contact and increase feeding or pumping frequency immediately
Frequent breast stimulation through increased feeding or pumping, combined with skin-to-skin contact, is the primary non-pharmacological intervention to trigger delayed lactogenesis II.
Question 7: When creating a feeding plan for a late preterm infant (34–36 weeks), which strategy is essential to prevent excessive weight loss?
- Feed on demand only, without scheduled checks
- Supplement with formula after every breastfeeding session
- Use a semi-demand schedule with a maximum of 3-hour intervals and monitor weight closely (Correct answer)
- Delay breastfeeding initiation until 37 weeks corrected age
Correct answer: Use a semi-demand schedule with a maximum of 3-hour intervals and monitor weight closely
Late preterm infants are sleepy and may not cue adequately, so a semi-demand schedule with maximum 3-hour intervals and close weight monitoring prevents dangerous weight loss.
CBS Treatment Planning & Management 2
A mother reports severe nipple pain described as burning and shooting pain between feedings.
What condition should the CBS suspect first?