Midwife Prometric exam questions

The Midwife exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Midwife practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Antenatal Care & Pregnancy (Low and High Risk)

   A woman at 10 weeks presents with severe vomiting, weight loss and a uterus large for dates. Ultrasound shows a 'snowstorm' appearance with no fetus, and beta-hCG is markedly elevated. After uterine evacuation of this molar pregnancy, what is the most important ongoing management?

   1. AImmediate conception is encouraged as soon as bleeding stops
   2. BSerial serum beta-hCG monitoring to detect persistent gestational trophoblastic disease
   3. CRoutine anti-D is never required regardless of rhesus status
   4. DNo follow-up is needed once the uterus is evacuated
   Show answer and explanation

   Correct answer: B. Serial serum beta-hCG monitoring to detect persistent gestational trophoblastic disease

   A complete hydatidiform mole requires registration and serial beta-hCG surveillance after evacuation to detect persistent or malignant gestational trophoblastic neoplasia, which may need chemotherapy. Pregnancy should be avoided until hCG normalises and follow-up is complete, so encouraging immediate conception or omitting follow-up is unsafe.

   Reference: RCOG Green-top Guideline No. 38: Gestational Trophoblastic Disease (2020)

2. Question 2 · Postpartum & Newborn Care

   On postnatal review, a woman who sustained a third-degree perineal tear reports involuntary loss of flatus and difficulty controlling stool. What is the most appropriate midwifery action?

   1. AReassure her this is normal and needs no follow-up
   2. BRefer for specialist assessment as these are symptoms of anal sphincter dysfunction
   3. CAdvise increased dietary fibre only and no referral
   4. DRecommend she avoid pelvic floor exercises permanently
   Show answer and explanation

   Correct answer: B. Refer for specialist assessment as these are symptoms of anal sphincter dysfunction

   Symptoms of faecal or flatus incontinence after a third-degree (obstetric anal sphincter injury, OASI) tear indicate possible sphincter dysfunction and require referral for specialist assessment, which may include physiotherapy and colorectal/urogynaecology input. These symptoms are not normal, fibre advice alone is inadequate, and pelvic floor exercises are actually encouraged as part of management.

   Reference: RCOG Green-top Guideline No. 29 Third- and Fourth-degree Perineal Tears (2015)

3. Question 3 · Gynecology & Women's Health

   A 52-year-old woman with an intact uterus and troublesome vasomotor symptoms wishes to start hormone replacement therapy. Why must a progestogen be combined with the oestrogen rather than giving oestrogen alone?

   1. ATo improve control of hot flushes
   2. BTo protect the endometrium from hyperplasia and cancer
   3. CTo reduce the risk of venous thromboembolism
   4. DTo enhance bone density more effectively
   Show answer and explanation

   Correct answer: B. To protect the endometrium from hyperplasia and cancer

   In a woman with a uterus, unopposed oestrogen stimulates the endometrium and increases the risk of endometrial hyperplasia and carcinoma, so a progestogen is added to provide endometrial protection. The progestogen is not needed for symptom control (oestrogen relieves vasomotor symptoms), does not reduce thrombosis risk, and is not required for bone benefit; women without a uterus can safely use oestrogen alone.

   Reference: NICE NG23, Menopause: Diagnosis and Management (2015, updated 2019)

4. Question 4 · Pharmacology in Midwifery

   A woman with epilepsy of childbearing age is being counselled about her antiepileptic drug. Which agent carries the highest risk of major congenital malformations and neurodevelopmental impairment and should be avoided in pregnancy where possible?

   1. ASodium valproate
   2. BLamotrigine
   3. CLevetiracetam
   4. DFolic acid
   Show answer and explanation

   Correct answer: A. Sodium valproate

   Sodium valproate carries the highest risk of major congenital malformations (including neural tube defects) and neurodevelopmental impairment, and must be avoided in pregnancy unless there is no alternative, with a pregnancy prevention programme. Lamotrigine and levetiracetam are relatively safer choices, and folic acid is protective, not teratogenic.

   Reference: MHRA Valproate Safety Guidance (2018); NICE Epilepsies NG217 (2022)

5. Question 5 · Labour, Delivery & Obstetric Emergencies (Intrapartum)

   A woman in threatened preterm labour at 30 weeks is being considered for magnesium sulphate. What is the primary purpose of administering magnesium sulphate in this situation?

   1. ATo achieve long-term tocolysis and stop labour
   2. BFetal neuroprotection to reduce the risk of cerebral palsy
   3. CTo lower maternal blood pressure
   4. DTo promote fetal lung surfactant production
   Show answer and explanation

   Correct answer: B. Fetal neuroprotection to reduce the risk of cerebral palsy

   Magnesium sulphate given before anticipated early preterm birth (generally before 30-34 weeks) provides fetal neuroprotection, reducing the risk of cerebral palsy and gross motor dysfunction. It is not an effective long-term tocolytic. Blood pressure control and lung maturation are achieved by antihypertensives and corticosteroids respectively, not by magnesium's neuroprotective use.

   Reference: RCOG Green-top Guideline No. 74 / Magnesium Sulphate Guidance (2022); ACOG Committee Opinion 455/652

6. Question 6 · Pre-pregnancy, Preconception & Family Planning

   A 28-year-old woman with chronic hypertension controlled on an ACE inhibitor attends for preconception advice. What is the most appropriate management of her antihypertensive therapy?

   1. AContinue the ACE inhibitor throughout pregnancy as it is safest
   2. BSwitch to a pregnancy-appropriate agent such as labetalol, nifedipine or methyldopa before conception
   3. CStop all antihypertensive medication regardless of blood pressure
   4. DAdd a thiazide diuretic to the ACE inhibitor
   Show answer and explanation

   Correct answer: B. Switch to a pregnancy-appropriate agent such as labetalol, nifedipine or methyldopa before conception

   ACE inhibitors and ARBs are fetotoxic (renal dysgenesis, oligohydramnios, skull defects) and should be changed preconceptionally to agents with an established safety profile such as labetalol, nifedipine or methyldopa. Continuing the ACE inhibitor risks fetal harm, and abruptly stopping all treatment may leave dangerous hypertension uncontrolled. Adding a thiazide does not remove the teratogenic exposure.

   Reference: NICE NG133 Hypertension in Pregnancy (2019)

7. Question 7 · Professionalism, Ethics, Patient Safety, Counselling & Education

   A midwife has a genuine, evidence-based concern that a newborn will be at significant risk of harm at home due to serious safeguarding issues. The mother asks her to keep the information private. What is the most appropriate action regarding confidentiality?

   1. AKeep the information completely confidential because the mother requested it
   2. BShare relevant information with the appropriate safeguarding agencies, as child protection overrides confidentiality when there is significant risk of harm
   3. CDiscuss the concern only informally with a colleague and take no formal action
   4. DWait until harm occurs before informing anyone
   Show answer and explanation

   Correct answer: B. Share relevant information with the appropriate safeguarding agencies, as child protection overrides confidentiality when there is significant risk of harm

   Confidentiality is not absolute; when a child is at significant risk of harm, the duty to safeguard overrides confidentiality and relevant information must be shared with the appropriate safeguarding agencies following local child-protection procedures. Absolute confidentiality, informal-only discussion, or waiting for harm to occur would fail the duty to protect the child.

   Reference: WHO Child Maltreatment prevention guidance; NMC The Code, 2018; local child safeguarding/child protection legislation

8. Question 8 · Antenatal Care & Pregnancy (Low and High Risk)

   Which statement best describes oxygen and nutrient transfer across the placenta?

   1. AOxygen crosses by active transport against its gradient
   2. BOxygen crosses by simple diffusion while glucose crosses by facilitated diffusion
   3. CGlucose crosses by simple diffusion only
   4. DAmino acids cross by passive diffusion down their concentration gradient
   Show answer and explanation

   Correct answer: B. Oxygen crosses by simple diffusion while glucose crosses by facilitated diffusion

   Oxygen crosses the placenta by simple diffusion down its partial-pressure gradient, aided by fetal haemoglobin's higher oxygen affinity, while glucose is transported by facilitated diffusion using GLUT transporters. Amino acids are moved by active transport against a gradient, so the statements describing active transport of oxygen, simple diffusion of glucose, or passive diffusion of amino acids are incorrect.

   Reference: Cunningham FG et al., Williams Obstetrics, 26th ed. (2022)

9. Question 9 · Postpartum & Newborn Care

   A term newborn is apnoeic and floppy at birth. After drying, stimulating and ensuring an open airway, the baby is still not breathing. According to newborn life support principles, what is the next priority intervention?

   1. ABegin chest compressions immediately
   2. BGive five inflation breaths to aerate the lungs
   3. CAdminister intravenous adrenaline
   4. DGive a fluid bolus
   Show answer and explanation

   Correct answer: B. Give five inflation breaths to aerate the lungs

   In newborn resuscitation, after drying, stimulating and opening the airway, the key first step for an apnoeic baby is to deliver five inflation breaths to aerate the lungs, as most newborns respond to effective lung inflation alone. Chest compressions are only started if the heart rate remains below 60 bpm despite effective ventilation, and adrenaline/fluids are later steps if the baby fails to respond.

   Reference: Resuscitation Council UK Newborn Life Support (2021); ILCOR/NRP guidelines

10. Question 10 · Gynecology & Women's Health

    A woman treated for a chlamydial pelvic infection is counselled about long-term risks. Which complication is most directly related to tubal damage from pelvic inflammatory disease?

    1. AIncreased risk of ectopic pregnancy and tubal factor infertility
    2. BDevelopment of cervical intraepithelial neoplasia
    3. COvarian hyperstimulation
    4. DUterine fibroid formation
    Show answer and explanation

    Correct answer: A. Increased risk of ectopic pregnancy and tubal factor infertility

    PID causes inflammation and scarring of the fallopian tubes, which impairs ovum transport and predisposes to both ectopic pregnancy and tubal factor infertility. Cervical intraepithelial neoplasia is driven by HPV, not PID, while ovarian hyperstimulation relates to fertility drugs and fibroids are hormone-dependent benign tumours unrelated to tubal infection.

    Reference: RCOG/BASHH Guideline on the Management of Pelvic Inflammatory Disease (2019)

11. Question 11 · Pharmacology in Midwifery

    Methyldopa is being reviewed for a woman at her 6-week postnatal visit. Why is it generally recommended to switch away from methyldopa in the postnatal period?

    1. AIt suppresses lactation
    2. BIt causes neonatal hyperglycaemia through breast milk
    3. CIt is associated with an increased risk of postnatal depression
    4. DIt has no antihypertensive effect after delivery
    Show answer and explanation

    Correct answer: C. It is associated with an increased risk of postnatal depression

    Methyldopa is associated with an increased risk of depression and is generally stopped within two days of birth and replaced with an alternative to reduce the risk of contributing to postnatal depression. It does not suppress lactation, does not cause neonatal hyperglycaemia, and retains antihypertensive activity postnatally.

    Reference: NICE Hypertension in Pregnancy NG133 (2019)

12. Question 12 · Antenatal Care & Pregnancy (Low and High Risk)

    A woman at 34 weeks has a blood pressure of 150/100 mmHg and 2+ proteinuria. Which additional finding would specifically indicate HELLP syndrome rather than pre-eclampsia alone?

    1. AHaemolysis with elevated liver enzymes and low platelets
    2. BIsolated headache and visual disturbance
    3. CGeneralised oedema of the ankles
    4. DSerum urate at the upper limit of normal
    Show answer and explanation

    Correct answer: A. Haemolysis with elevated liver enzymes and low platelets

    HELLP syndrome is defined by Haemolysis, Elevated Liver enzymes and Low Platelets, a severe variant of pre-eclampsia. Headache, visual symptoms and oedema may occur in pre-eclampsia but are not diagnostic of HELLP. Urate elevation supports pre-eclampsia generally but is not part of the HELLP triad.

    Reference: NICE NG133 Hypertension in pregnancy, 2019

Midwife reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Midwife questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.