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Substance Use During Pregnancy and Breastfeeding

1. Which of the following statements best defines the term "substance use disorder (SUD)?"      

A. SUD may refer to the use of any substance, such as alcohol or drugs.

B. SUD may refer to the use of more than one substance.

C. SUD may refer to a problematic pattern of opioid use that leads to clinically significant impairment or distress.

D. SUD may refer to a disorder that occurs when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.


2. Which of the following best represents a warning sign of preterm labor?    

A. Contractions every 10 minutes or more

B. Contractions every 30 minutes

C. Weight loss

D. Loss of appetite


3. A health care professional has questions regarding low birth weight. Which of the following informational points of interest should be communicated to the health care professional?    

A. Low birth weight is when a baby is born weighing less than eight pounds.

B. Low birth weight is when a baby is born weighing between seven and nine pounds.

C. Tobacco use may lead to low birth weight.

D. Tobacco use does not typically lead to low birth weight.


4. Which of the following best represents a sign/symptom of FASDs?    

A. A large head

B. Flared nostrils

C. Large ear lobes

D. Abnormal facial features, such as a smooth ridge between the nose and upper lip


5. A 28-year-old pregnant patient has questions regarding ARND. Which of the following educational points should be expressed to the patient?    

A. Individuals suffering from ARND typically have intellectual disabilities and problems with behavior and learning.

B. Individuals suffering from ARND do not typically have intellectual disabilities, however, they do have problems with behavior.

C. Alcohol use during pregnancy does not lead to ARND.

D. Individuals under the age of 30 can have up to three alcoholic drinks per day.


6. Which of the following best represents a complication associated with NAS?    

A. Small head

B. Developmental delays

C. High birth weight

D. Hormonal changes


7. A 22-year-old patient has questions regarding SIDS. Which of the following educational points should be expressed to the patient?    

A. SIDS may refer to the sudden, unexplained death of a baby younger than two years old.

B. SIDS is a type of suffocation.

C. Girls are at greater risk for SIDS.

D. Babies who typically sleep on their backs, and are then placed on their stomachs to sleep (e.g., for a nap) are at very high risk for SIDS.


8. Which of the following best represents an ACOG recommendation regarding substance use and pregnancy?    

A. Individuals should stop smoking before pregnancy, however stopping smoking during pregnancy is better than not stopping at all.

B. Individuals may use e-cigarettes during pregnancy.

C. Individuals do not have to avoid smokeless tobacco during pregnancy.

D. Pregnant individuals who are dependent on alcohol should not receive counseling past the first trimester.


9. Which of the following statements is most accurate?    

A. The AAP recommends exclusive breastfeeding of infants for the first month of life before introducing nutritious complementary foods, while encouraging social and systemic changes to support mothers who choose to breastfeed.

B. The AAP recommends exclusive breastfeeding of infants for the first two months of life before introducing nutritious complementary foods, while encouraging social and systemic changes to support mothers who choose to breastfeed.

C. The AAP recommends exclusive breastfeeding of infants for the first four months of life before introducing nutritious complementary foods, while encouraging social and systemic changes to support mothers who choose to breastfeed.

D. The AAP recommends exclusive breastfeeding of infants for the first six months of life before introducing nutritious complementary foods, while encouraging social and systemic changes to support mothers who choose to breastfeed.


10. Which of the following best represents a contraindication to breastfeeding?    

A. The newborn child is diagnosed with classic galactosemia.

B. The new mother cannot express breast milk.

C. The new mother had COVID-19 in the past four months.

D. The new mother had COVID-19 in the past six months.


11. A health care professional is developing an educational lecture focused on the Academy of Breastfeeding Medicine's recommendations for substance use and breastfeeding. Which of the following educational points should be included in the health care professional's lecture?    

A. Health care professionals should encourage stable methadone-maintained individuals to breastfeed if their methadone dose is 20 mg or lower.

B. Health care professionals should encourage stable buprenorphine-maintained individuals to breastfeed if their dose is less than 5 mg per day.

C. Health care professionals should encourage stable methadone- or buprenorphine-maintained individuals to breastfeed regardless of dose.

D. Health care professionals should not encourage stable methadone- or buprenorphine-maintained individuals to breastfeed.


12. Which of the following statements is most accurate?    

A. The American Academy of Pediatrics and the World Health Organization advise waiting 20 minutes after ingesting alcohol before breastfeeding.

B. The American Academy of Pediatrics and the World Health Organization advise waiting 30 minutes after ingesting alcohol before breastfeeding.

C. The American Academy of Pediatrics and the World Health Organization advise waiting 90 - 120 minutes after ingesting alcohol before breastfeeding, or expressing and discarding milk within that time frame.

D. The American Academy of Pediatrics and the World Health Organization advise waiting 24 hours after ingesting alcohol before breastfeeding, or expressing and discarding milk within that time frame.


13. A 30-year-old pregnant patient has questions regarding breastfeeding and illicit drug use. Which of the following educational points should be expressed to the patient?    

A. Individuals should avoid breastfeeding if they relapse to illicit drug use or legal substance misuse within the 10-day period prior to delivery.

B. Individuals should avoid breastfeeding if they relapse to illicit drug use or legal substance misuse within the 15-day period prior to delivery.

C. Individuals should avoid breastfeeding if they relapse to illicit drug use or legal substance misuse within the 20-day period prior to delivery.

D. Individuals should avoid breastfeeding if they relapse to illicit drug use or legal substance misuse within the 30-day period prior to delivery.


14. Which of the following statements is most accurate?    

A. Passive drug exposures do not pose a risk to an infant.

B. Passive drug exposures do not pose a risk to infants over the age of four months.

C. Passive drug exposures may pose additional risk to the infant; therefore, any woman relapsing to illicit drug use or legal substance misuse after the establishment of lactation should be provided an appropriate human milk substitute.

D. Human milk substitutes should not be used for any reason.


15. A health care professional has questions regarding methadone. Which of the following informational points of interest should be communicated to the health care professional?    

A. Methadone is a synthetic, long-acting, full mu opioid receptor agonist that can produce analgesia, sedation, euphoria, and respiratory depression by binding to mu opioid receptors.

B. Methadone is a synthetic mu opioid receptor partial agonist approved by the Food and Drug Administration for use in maintenance treatment for opioid use disorder.

C. Methadone does not cause respiratory depression.

D. Methadone does not cause euphoria.


16. Which of the following starting doses should be used for an individual with a low opioid tolerance?    

A. 5 mg

B. 20 mg

C. 40 mg

D. 80 mg


17. A 32-year-old patient has questions regarding MAT and methadone. Which of the following educational points should be expressed to the patient?    

A. NAS cannot occur in newborns of mothers treated with methadone.

B. NAS cannot occur in newborns of mothers treated with methadone for a period of less than two months.

C. NAS cannot occur in newborns of mothers treated with methadone for a period of less than six months.

D. NAS can occur in newborns of mothers treated with methadone.


18. A 21-year-old patient has questions regarding MAT and buprenorphine. Which of the following educational points should be expressed to the patient?    

A. Patients will not experience opioid withdrawal if they stop buprenorphine.

B. Patients over the age of 16 will not experience opioid withdrawal if they stop buprenorphine.

C. Patients over the age of 18 will not experience opioid withdrawal if they stop buprenorphine.

D. Patients will experience opioid withdrawal if they stop buprenorphine.


19. Which of the following statements best defines the term "group therapy?"    

A. Group therapy may refer to a therapy modality wherein individuals learn and practice recovery strategies, build interpersonal skills, and reinforce and develop social support networks.

B. Group therapy may refer to a therapy modality wherein individuals learn and practice recovery strategies in an inpatient setting for a period of six weeks or longer.

C. Group therapy may refer to a therapy modality wherein individuals learn and practice recovery strategies and receive skills to help avoid relationships.

D. Group therapy may refer to a therapy modality wherein individuals learn and practice recovery strategies and receive drug treatment monitoring.


20. Which of the following strategies may be used by health care professionals to effectively improve group cohesion?    

A. Prevent member - member interactions.

B. Set a rigid group agenda.

C. Close the group to members that show up late on a regular basis.

D. Ask members to share if they ever experienced a similar circumstance, feeling, or thought as expressed by a specific group member.


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