There are 175 different exam questions on the IBLCE exam. You might assume that means there are 175 different answers. Well, I suppose it depends on how you count! I’m here to tell you that there are only 4 (maybe 5) “different” answers.
Some of the items on the IBLCE exam test at the comprehension level. These test your ability to simply recall facts or concepts. Here’s an example: “Of the drugs listed below, which one is lipophilic?” To answer this question, you only need to recall something you’ve learned. You either know that information, or you don’t. However, there very few of recall-only exam questions.
The vast majority of IBLCE exam questions about clinical management are at the application level. The stem of the question presents a short vignette, and you are asked to identify some kind of “action” you would take as an IBCLC. The answer to the question boils down to four actions: Reassure, Respond, Resolve, or Refer.
Exam Questions and Answers #1: Reassure
Sometimes, the vignette describes data collected in a normal situation. For example, it might address a mother’s milk supply, a baby’s intake or output, or a photo showing an optimal latch. It could call on you to recognize growth and development milestones. As the exam-taker, you must be able to identify that a situation is optimal, or at least within normal parameters. Pick the option that will reassure the mother that this is normal.
Exam Questions and Answers #2: Respond
The vignette might describe a mostly normal situation, but with some action that is going on with a foreseeable “next step” to be done by the parent or the professional. For example, the mother is trying to decide on a feeding method, is going for a mammogram, or wants to know if consuming Gatorade will help to increase her milk supply.
In these and similar situations, you’ll need to pick the option that responds appropriately. Responding almost always involves reflective listening, guiding, leading, or educating.
Exam Question and Answer #3: Resolve
Other times, the vignette describes—either in words or in a clinical photo—a suboptimal or abnormal situation. In this case, you will need to resolve a problem. You’ll need to recognize that the situation is not normal and requires some correction. You’ll also need to be sure that the action needed to resolve the problem is within your scope of practice.
For example, let’s say the exam item shows a photo of a bleb on a nipple. The stem of the question asks what the IBCLC would do to help the mother. One of the options is, soak the breast is warm water or warm salt water. Soaking the breast in water or salt water would be a safe option that is within the IBCLC’s scope of practice. Another option is to perform a needle aspiration. The needle aspiration would likely resolve the problem, but that’s not within your scope of practice!
Exam Questions and Answers #4: Refer
In the above-mentioned case, let’s say that you and the mother have already tried all of the simple remedies to resolve the bleb, but it persists, and the mother is still uncomfortable. That’s the time to refer.
I’ve noticed that people who take one of our practice exams often pick the option that says to “call the doctor.” However, the only time “call the doctor” is the correct answer is when you are not able or authorized to fix the problem.
Admittedly, I make this sound easier than it really is! But I do believe that it’s a good approach, when taking the IBLCE exam, to think about the need that’s expressed in the vignette. In normal situations, reassurance is all that is needed. If the mother, the family, or a colleague has a lack of clarity or a sense of uneasiness, the need is for a response. Situations that are abnormal or might later be abnormal need problem-resolution. Situations outside of your scope of practice need a referral.
Exam questions aren’t always easy, but by thinking about the need and your scope of practice, you’ll find it’s easier to pick the right answers.