Updated Midwifery Past Questions and Answers

Surviving the NMCN Midwifery Professional Examination

If you are reading this, you are likely standing at the precipice of one of the most defining moments in your career as a Nigerian health professional: The Nursing and Midwifery Council of Nigeria (NMCN) Professional Examination.

Passing this exam is not just about getting a license; it is about proving that you possess the competence, the knowledge, and the grit to save lives in our Nigerian healthcare system. Whether you are a student at a School of Basic Midwifery, a Department of Nursing Science in a university, or preparing for the Post-Basic Midwifery program, the anxiety is real.

“Success is not final, failure is not fatal: It is the courage to continue that counts.” – Winston Churchill.

At Manny Spark, we believe that preparation is the antidote to anxiety. This article is not just a list of questions; it is a comprehensive educational resource. We have compiled high-yield past questions, but more importantly, we have provided detailed rationales for the answers. Understanding why an answer is correct is the key to tackling the new Computer Based Test (CBT) format introduced by the council.

Who is Dr. Manny and What is Manny Spark?

I am Dr. Manny, and my brand, Manny Spark, is dedicated to lighting the path for medical and nursing students across Nigeria. We understand that the volume of material in midwifery—from the anatomy of the fetal skull to the complexities of pre-eclampsia—can be overwhelming.

Manny Spark is more than just a name; it is an educational hub designed to simplify complex medical concepts.

• Our Mission: To reduce the failure rate in NMCN exams by providing accessible, high-quality tutorials.

• Our Approach: We break down heavy textbooks into digestible, easy-to-understand lectures and notes.

You can reach out to us directly for personalized tutorials, mock exams, and guidance.

Contact Dr. Manny: 08039822082 or 08056553153.

The New CBT Format: What Nigerian Students Must Know

Takeaway: The Shift to Objective Questions

The Nursing and Midwifery Council of Nigeria has largely transitioned to Computer Based Tests (CBT). This means:

1. Speed is Crucial: You have limited time to answer multiple-choice questions (MCQs).

2. Precision is Key: Unlike theory essays where you can “pad” your answer, CBT is binary. You are either right or wrong.

3. Critical Thinking: Questions are often scenario-based (e.g., “A 25-year-old primigravida presents with…”).

Section A: Anatomy and Physiology of the Reproductive System

To understand midwifery, you must master the vessel of life: the female pelvis and reproductive organs.

Question 1

The landmark of the pelvis that divides the false pelvis from the true pelvis is known as:

A) The Ischial Spines

B) The Iliopectineal Line (Brim)

C) The Sacral Promontory

D) The Symphysis Pubis

Answer: B) The Iliopectineal Line (Brim)

Dr. Manny’s Rationale:

The pelvis is divided into two parts: the False Pelvis (above the brim) and the True Pelvis (below the brim). The Iliopectineal line (also called the pelvic brim or inlet) is the bony ridge that delineates these two areas. The true pelvis is the bony canal through which the fetus must pass during birth.

• Note: The Ischial spines are crucial for determining the station of the fetal head during labour, not for dividing the pelvis sections.

Question 2

Which layer of the uterus is functionally responsible for the menstrual cycle shedding and implantation of the fertilized ovum?

A) Perimetrium

B) Myometrium

C) Endometrium

D) Parametrium

Answer: C) Endometrium

Dr. Manny’s Rationale:

• Endometrium: The inner mucosal lining. It has two layers: the stratum functionalis (which sheds during menstruation) and the stratum basalis (which regenerates the layer).

• Myometrium: The middle muscle layer responsible for contractions during labour (heavily influenced by Oxytocin).

• Perimetrium: The outer serous layer.

Question 3

The Graafian follicle secretes which major hormone before ovulation?

A) Progesterone

B) Luteinizing Hormone (LH)

C) Estrogen

D) Prolactin

Answer: C) Estrogen

Dr. Manny’s Rationale:

During the follicular phase of the ovarian cycle, the developing follicle (Graafian follicle) produces increasing amounts of Estrogen. This rise in estrogen triggers the LH surge, which causes ovulation. After ovulation, the follicle becomes the Corpus Luteum, which then secretes Progesterone to maintain the pregnancy.

Section B: Antenatal Care (Normal Midwifery)

Antenatal care (ANC) in Nigeria focuses on the “Basic 4 Visits” (though WHO now recommends 8 contacts) and the prevention of malaria and anemia.

Question 4

A pregnant woman at 30 weeks gestation complains of physiological anaemia. What is the primary cause of this condition?

A) Iron deficiency due to poor diet

B) Hemodilution due to increased plasma volume

C) Sickle cell crisis

D) Blood loss from hemorrhoids

Answer: B) Hemodilution due to increased plasma volume

Dr. Manny’s Rationale:

In pregnancy, the blood volume increases by about 40-50%. However, the plasma volume increases more than the red blood cell mass. This causes a “dilutional” effect, lowering the hemoglobin concentration. This is normal (physiological). However, in Nigeria, we must always rule out pathological anemia caused by malaria or hookworm infestation.

Question 5

Using Naegele’s Rule, calculate the Expected Date of Delivery (EDD) for a woman whose Last Menstrual Period (LMP) was 10th June 2024.

A) 17th March 2025

B) 10th March 2025

C) 17th February 2025

D) 17th April 2025

Answer: A) 17th March 2025

Dr. Manny’s Rationale:

Naegele’s Rule Formula: LMP + 7 Days – 3 Months + 1 Year.

• Step 1 (Add 7 Days): 10th June + 7 = 17th June.

• Step 2 (Subtract 3 Months): June (6) – 3 = March (3).

• Step 3 (Add 1 Year): 2024 + 1 = 2025.

• Result: 17th March 2025.

Question 6

Which of the following vaccines is contraindicated during pregnancy?

A) Tetanus Toxoid

B) Hepatitis B

C) Measles, Mumps, and Rubella (MMR)

D) Influenza

Answer: C) Measles, Mumps, and Rubella (MMR)

Dr. Manny’s Rationale:

Live attenuated vaccines, such as MMR, Varicella (Chickenpox), and Oral Polio Vaccine (OPV), are generally contraindicated in pregnancy because of the theoretical risk of the virus crossing the placenta and infecting the fetus. Tetanus Toxoid is mandatory for pregnant women in Nigeria to prevent Neonatal Tetanus.

Section C: Intranatal Care (Labour and Delivery)

This is the core of midwifery. You must distinguish between true labour and false labour.

Table: True Labour vs. False Labour

Feature	True Labour	False Labour
Contractions	Regular, increase in frequency and intensity	Irregular, often stop with activity
Cervical Change	Progressive dilation and effacement	No significant change in cervix
Pain Location	Starts in back, radiates to abdomen	Mostly lower abdomen or groin
Effect of Sedation	Sedation does not stop true labour	Sedation often stops the discomfort

Question 7

The mechanism of labour for a fetus in the Left Occipito-Anterior (LOA) position involves the following movements in order:

A) Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion

B) Flexion, Descent, Internal Rotation, Restitution, Extension, Expulsion

C) Extension, Flexion, Internal Rotation, Descent, Expulsion

D) Descent, Internal Rotation, Flexion, Extension, External Rotation, Expulsion

Answer: A) Descent, Flexion, Internal Rotation, Extension, Restitution, External Rotation, Expulsion

Dr. Manny’s Rationale:

This is a classic “order of events” question.

1. Descent: The head moves down.

2. Flexion: Chin touches chest (smallest diameter presents).

3. Internal Rotation: The head rotates to fit the pelvic outlet.

4. Extension: The head is born (crowning and delivery).

5. Restitution: The head untwists to align with shoulders.

6. External Rotation: Shoulders rotate.

7. Expulsion: The body is born.

Question 8

During the third stage of labour, which sign indicates placental separation?

A) The uterus becomes boggy and large

B) A gush of blood and lengthening of the umbilical cord

C) The mother feels the urge to push again

D) Rapid drop in maternal blood pressure

Answer: B) A gush of blood and lengthening of the umbilical cord

Dr. Manny’s Rationale:

There are three classic signs of placental separation:

1. Lengthening of the cord: As the placenta drops into the lower segment.

2. Gush of blood: Retro-placental clot is released.

3. Change in uterine shape: The uterus becomes globular and rises in the abdomen (Calkin’s sign).If the uterus becomes “boggy,” it indicates uterine atony (hemorrhage risk), not separation.

Section D: Postnatal Care and the Puerperium

The puerperium is the 6-week period following childbirth.

Question 9

A woman 24 hours postpartum has a fundal height at the level of the umbilicus. Is this normal?

A) No, it should be at the symphysis pubis.

B) Yes, this is a normal finding.

C) No, it indicates retained placental tissue.

D) No, it indicates a full bladder.

Answer: B) Yes, this is a normal finding.

Dr. Manny’s Rationale:

Immediately after delivery, the fundus is roughly at the level of the umbilicus (or slightly below). It descends approximately 1 finger breadth (1 cm) per day. By the 10th-14th day, it should no longer be palpable abdominally (it becomes a pelvic organ).

Question 10

What is the primary characteristic of Lochia Rubra?

A) Pinkish-brown color, lasting days 4-10

B) Yellowish-white color, lasting days 11-21

C) Bright red color, lasting days 1-3

D) Foul-smelling green discharge

Answer: C) Bright red color, lasting days 1-3

Dr. Manny’s Rationale:

• Lochia Rubra: Red (blood, decidua). Days 1-3.

• Lochia Serosa: Pink/Brown (serum, leukocytes). Days 4-10.

• Lochia Alba: White/Yellow (mucus, leukocytes). Days 11-21+.

• Note: Foul smell indicates infection (Puerperal Sepsis).

Section E: Complications in Midwifery (Abnormal)

This section often carries the highest marks in NMCN exams because managing complications saves lives.

Question 11

A pregnant woman presents with painless, bright red vaginal bleeding at 34 weeks. The uterus is soft and non-tender. What is the most likely diagnosis?

A) Abruptio Placentae

B) Placenta Previa

C) Uterine Rupture

D) Vasa Previa

Answer: B) Placenta Previa

Dr. Manny’s Rationale:

• Placenta Previa: Painless bleeding. The placenta covers the cervix. The uterus remains soft because blood isn’t trapped in the muscle.

• Abruptio Placentae: Painful bleeding (board-like, rigid uterus). The placenta detaches prematurely.

• Takeaway: Never perform a vaginal examination (VE) on a woman with antepartum hemorrhage until Placenta Previa is ruled out via ultrasound!

Question 12

Which drug is the gold standard for preventing and treating seizures in Eclampsia?

A) Diazepam

B) Phenytoin

C) Magnesium Sulfate (MgSO4)

D) Labetalol

Answer: C) Magnesium Sulfate (MgSO4)

Dr. Manny’s Rationale:

Magnesium Sulfate is the anticonvulsant of choice. It acts as a CNS depressant.

• Antidote: Calcium Gluconate (must always be at the bedside).

• Monitoring: Monitor Respiratory Rate (must be >12/min), Urine Output (>30ml/hr), and Deep Tendon Reflexes (must be present) to prevent toxicity.

Question 13

Postpartum Hemorrhage (PPH) is defined as blood loss greater than:

A) 200ml

B) 300ml

C) 500ml

D) 1000ml

Answer: C) 500ml

Dr. Manny’s Rationale:

• Vaginal Delivery: >500ml is PPH.

• Cesarean Section: >1000ml is PPH.

• Primary PPH: Occurs within 24 hours (Causes: 4 Ts – Tone, Trauma, Tissue, Thrombin).

• Secondary PPH: Occurs after 24 hours up to 6 weeks (usually infection or retained tissue).

Section F: Community Midwifery and Primary Health Care Nigeria places a heavy emphasis on Primary Health Care (PHC).

Question 14

Under the Nigerian National Programme on Immunization (NPI), at what age is the Measles vaccine given?

A) At Birth

B) 6 Weeks

C) 9 Months

D) 18 Months

Answer: C) 9 Months

Dr. Manny’s Rationale:

Measles vaccine is strictly given at 9 months. If given earlier, maternal antibodies might neutralize the vaccine, rendering it ineffective. A second dose (Measles 2) is often given at 15-18 months in updated schedules.

Question 15

The “Three Delays” model contributing to maternal mortality in Nigeria includes all EXCEPT:

A) Delay in deciding to seek care

B) Delay in reaching the health facility

C) Delay in receiving adequate care at the facility

D) Delay in the onset of labour

Answer: D) Delay in the onset of labour

Dr. Manny’s Rationale:

The Three Delays Model explains why women die:

1. Phase 1: Delay in decision-making (culture, money, permission).

2. Phase 2: Delay in transport (bad roads, distance).

3. Phase 3: Delay in service delivery (lack of staff, equipment, or drugs at the hospital).

Section G: Pharmacology in Midwifery

Question 16

Oxytocin (Syntocinon) is used for all the following EXCEPT:

A) Induction of labour

B) Augmentation of labour

C) Management of Third Stage of Labour

D) Treatment of Pre-term Labour

Answer: D) Treatment of Pre-term Labour

Dr. Manny’s Rationale:

Oxytocin causes contractions. In pre-term labour, we want to stop contractions (Tocolysis). Giving Oxytocin would worsen pre-term labour. Drugs used for Tocolysis include Nifedipine or Salbutamol.

Question 17

What is the specific action of Ergometrine on the uterus?

A) Relaxes the lower uterine segment

B) Causes sustained, tetanic contraction of the uterus

C) Softens the cervix

D) Increases placental perfusion

Answer: B) Causes sustained, tetanic contraction of the uterus

Dr. Manny’s Rationale:

Ergometrine causes a strong, sustained contraction. It is excellent for preventing PPH but dangerous if the fetus is still inside (can cause asphyxia or rupture) or if there is an undiagnosed twin. It is also contraindicated in hypertension/pre-eclampsia as it raises blood pressure.

Dr. Manny’s Exclusive Study Strategies

Preparing for the NMCN exam requires strategy, not just hard work. Here is how I advise my students at Manny Spark to prepare:

1. Master the “Normal” First: You cannot understand abnormal midwifery (pathology) if you do not understand the normal physiology of pregnancy and labour. Spend 60% of your time on Normal Midwifery.

2. Practice Speed: In the CBT exam, you don’t have time to second-guess. Practice answering 100 questions in 60 minutes.

3. Know Your Values: Memorize normal lab values (Hb, BP, Urinalysis) and fetal measurements (BPD, FL).

4. Group Study: Discussing scenarios with friends helps retention.

5. Use Mnemonics: For example, BUBBLE-HE for postpartum assessment (Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homan’s sign, Emotional status).

“Education is the passport to the future, for tomorrow belongs to those who prepare for it today.” – Malcolm X.

Manny Spark Tutorial Services: Where to Find Us

At Manny Spark, we offer intensive coaching for:

• General Nursing Council Exam

• Post-Basic Midwifery Exam

• School of Nursing Entrance Exams

We provide a conducive learning environment, up-to-date CBT practice software, and experienced tutors who are registered nurses and midwives.

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