Free Midwife mock test

Midwife sample questions with answers

10 more original exam-style Midwife questions, worked in full. They are not real or recalled exam questions, and none of them is in the mock above or on the bank page, so sit the mock first if you have not.

1. Question 1 · Labour, Delivery & Obstetric Emergencies (Intrapartum)

   A woman having a physiological (expectant) third stage has delivered the baby 45 minutes ago; the placenta remains undelivered with no bleeding and the uterus is well contracted. What is the most appropriate management?

   1. AContinue to wait indefinitely as there is no bleeding
   2. BRecommend changing to active management and, if the placenta is still undelivered, treat as a retained placenta
   3. CApply immediate controlled cord traction without a uterotonic
   4. DPerform manual removal on the labour bed without analgesia
   Show answer and explanation

   Correct answer: B. Recommend changing to active management and, if the placenta is still undelivered, treat as a retained placenta

   A third stage is regarded as prolonged after 30 minutes with active management or 60 minutes with physiological management; at 45 minutes physiologically with no delivery, the midwife should recommend switching to active management, and if the placenta remains undelivered it is a retained placenta requiring obstetric review and, usually, manual removal under regional or general anaesthesia. Waiting indefinitely and cord traction without a uterotonic or analgesia are unsafe.

   Reference: NICE NG235 Intrapartum care (2023); WHO recommendations for prevention and treatment of PPH (2012/2018)

2. Question 2 · Pre-pregnancy, Preconception & Family Planning

   A woman relying on the lactational amenorrhoea method (LAM) asks when it is no longer reliable as contraception. Which situation reduces its effectiveness?

   1. AShe is fully or nearly fully breastfeeding, amenorrhoeic, and less than 6 months postpartum
   2. BMenstruation returns, the infant reaches 6 months of age, or breastfeeding is no longer exclusive
   3. CThe infant is feeding on demand day and night
   4. DShe has no supplementary feeds and short intervals between feeds
   Show answer and explanation

   Correct answer: B. Menstruation returns, the infant reaches 6 months of age, or breastfeeding is no longer exclusive

   LAM is only reliable (about 98%) when all three criteria are met: amenorrhoea, exclusive or nearly exclusive breastfeeding, and infant under 6 months. Effectiveness falls when menses returns, the infant reaches 6 months, or feeding is no longer exclusive, at which point an additional method is needed. The other options describe conditions under which LAM remains effective.

   Reference: WHO/FSRH lactational amenorrhoea method guidance

3. Question 3 · Professionalism, Ethics, Patient Safety, Counselling & Education

   Why do standard (non-obstetric) early warning scores require modification for use in pregnant and recently pregnant women?

   1. APregnant women never become physiologically unstable
   2. BPregnant women cannot have their observations measured accurately
   3. CEarly warning scores are only valid in intensive care
   4. DNormal pregnancy alters baseline physiology (for example higher heart rate and lower blood pressure), so standard trigger thresholds may miss or falsely flag deterioration
   Show answer and explanation

   Correct answer: D. Normal pregnancy alters baseline physiology (for example higher heart rate and lower blood pressure), so standard trigger thresholds may miss or falsely flag deterioration

   Pregnancy produces physiological changes such as increased heart rate, increased cardiac output, lowered blood pressure in mid-pregnancy and a raised respiratory rate, so generic thresholds can either mask genuine deterioration or trigger inappropriately. Obstetric-specific charts recalibrate thresholds to these adaptations, improving detection. Pregnant women certainly can deteriorate and can be monitored anywhere.

   Reference: RCOG/MBRRACE-UK guidance on obstetric early warning systems; physiological changes of pregnancy

4. Question 4 · Antenatal Care & Pregnancy (Low and High Risk)

   A woman books at 15 weeks and has missed the window for the combined test. Which screening test is most appropriate to offer for Down syndrome at this gestation using maternal serum markers?

   1. AQuadruple test
   2. BNuchal translucency measurement alone
   3. CCombined test
   4. DFirst-trimester PAPP-A alone
   Show answer and explanation

   Correct answer: A. Quadruple test

   The combined test (nuchal translucency plus PAPP-A and beta-hCG) is offered between about 11+2 and 14+1 weeks; once this window has passed, the quadruple test (AFP, hCG, uE3, inhibin A) is the recommended serum screen from about 14+2 to 20 weeks. Nuchal translucency or PAPP-A alone are not offered as stand-alone screens. NIPT may be offered but the question specifies serum markers.

   Reference: NICE NG201 / UK NSC Fetal Anomaly Screening Programme, 2021

5. Question 5 · Postpartum & Newborn Care

   A woman is 24 hours postpartum. Her observations are: temperature 37.9 C, heart rate 118/min, respiratory rate 22/min, BP 96/58 mmHg. She feels generally unwell. According to a modified obstetric early warning approach, what is the most appropriate response?

   1. ARecord the observations and repeat in 12 hours
   2. BGive paracetamol and reassure that mild pyrexia is normal on day 1
   3. CDischarge home with advice to return if symptoms worsen
   4. DEscalate urgently to the obstetric/medical team for review as the pattern suggests possible sepsis
   Show answer and explanation

   Correct answer: D. Escalate urgently to the obstetric/medical team for review as the pattern suggests possible sepsis

   Tachycardia, tachypnoea, borderline hypotension, pyrexia and feeling unwell together trigger escalation on a modified obstetric early warning score and are red flags for maternal sepsis. Prompt senior review, investigations and the sepsis six should follow. Delaying repeat observations, giving only symptomatic treatment, or discharging the woman would risk rapid deterioration.

   Reference: RCOG Green-top Guideline No. 64b, Bacterial Sepsis following Pregnancy (2012)

6. Question 6 · Gynecology & Women's Health

   A 28-year-old woman at 7 weeks' gestation presents with sudden severe right iliac fossa pain, shoulder-tip pain, dizziness, tachycardia and hypotension. Her abdomen is tender with guarding. What is the most likely diagnosis?

   1. ARuptured ectopic pregnancy
   2. BThreatened miscarriage
   3. COvarian cyst without complication
   4. DUrinary tract infection
   Show answer and explanation

   Correct answer: A. Ruptured ectopic pregnancy

   Sudden severe unilateral pelvic pain with shoulder-tip pain (from diaphragmatic irritation by intraperitoneal blood) and signs of haemodynamic shock in early pregnancy strongly indicate a ruptured ectopic pregnancy, which is a surgical emergency. Threatened miscarriage causes bleeding with a closed cervix but not shock, an uncomplicated cyst does not cause collapse, and a UTI produces dysuria and frequency rather than acute haemorrhagic shock.

   Reference: RCOG/NICE Guideline NG126: Ectopic Pregnancy and Miscarriage (2019)

7. Question 7 · Pharmacology in Midwifery

   During maternal cardiopulmonary resuscitation at 34 weeks gestation, which specific manoeuvre is essential to improve the effectiveness of chest compressions and maternal circulation?

   1. AManual left lateral uterine displacement (relieving aortocaval compression)
   2. BPlacing the woman in the full right lateral position
   3. CWithholding defibrillation because of the pregnancy
   4. DElevating both legs to 90 degrees continuously
   Show answer and explanation

   Correct answer: A. Manual left lateral uterine displacement (relieving aortocaval compression)

   Manual left lateral uterine displacement relieves aortocaval compression by the gravid uterus, improving venous return and the effectiveness of CPR; perimortem caesarean is considered if there is no response by around 4 minutes. Full right lateral positioning worsens compression, defibrillation is not contraindicated in pregnancy, and continuous leg elevation is not the key intervention.

   Reference: Resuscitation Council UK - Maternal Cardiac Arrest / Advanced Life Support in Pregnancy; MBRRACE-UK

8. Question 8 · Labour, Delivery & Obstetric Emergencies (Intrapartum)

   McRoberts and suprapubic pressure have failed to relieve a shoulder dystocia after 60 seconds. According to standard algorithms, which action is the most appropriate next step?

   1. AApply stronger fundal pressure with two assistants
   2. BProceed to internal manoeuvres: attempt delivery of the posterior arm or internal rotation
   3. CPerform an immediate classical caesarean section
   4. DWait a further two minutes for spontaneous release
   Show answer and explanation

   Correct answer: B. Proceed to internal manoeuvres: attempt delivery of the posterior arm or internal rotation

   When first-line external manoeuvres fail, the algorithm proceeds to internal manoeuvres, delivery of the posterior arm, or internal rotational manoeuvres (Rubin/Wood's screw), often with an episiotomy to gain access. Fundal pressure is contraindicated. Delay increases the risk of hypoxic injury, and caesarean (Zavanelli/symphysiotomy) is a last resort only after internal manoeuvres fail.

   Reference: RCOG Green-top Guideline No. 42 (2012); ACOG Practice Bulletin 178 (2017)

9. Question 9 · Pre-pregnancy, Preconception & Family Planning

   A 29-year-old woman with epilepsy taking sodium valproate attends for preconception advice. What is the most appropriate action regarding her medication?

   1. ARefer promptly to her neurologist to review switching to a lower-risk antiepileptic before conception
   2. BContinue valproate unchanged as seizure control overrides all other concerns
   3. CStop all antiepileptic drugs immediately without specialist input
   4. DReassure her that valproate is safe in pregnancy
   Show answer and explanation

   Correct answer: A. Refer promptly to her neurologist to review switching to a lower-risk antiepileptic before conception

   Sodium valproate carries a high risk of major congenital malformations and neurodevelopmental impairment, so women of childbearing potential should be referred for specialist review to consider a safer alternative before conception under a pregnancy prevention programme. Continuing it unchanged ignores this teratogenic risk, while abruptly stopping antiepileptics risks dangerous seizures and must not be done without specialist input. Valproate is not safe in pregnancy.

   Reference: MHRA valproate Pregnancy Prevention Programme; NICE NG217 Epilepsies (2022)

10. Question 10 · Professionalism, Ethics, Patient Safety, Counselling & Education

    A midwife has just removed gloves after assisting a birth involving blood and amniotic fluid. Her hands are not visibly soiled. What is the most appropriate hand-hygiene method?

    1. ANo hand hygiene is needed because gloves were worn
    2. BUse alcohol-based handrub only, never soap, in all situations
    3. CPerform hand hygiene, and because there was body-fluid contact, washing with soap and water is preferred if any doubt about soiling
    4. DRinse with plain water without soap or handrub
    Show answer and explanation

    Correct answer: C. Perform hand hygiene, and because there was body-fluid contact, washing with soap and water is preferred if any doubt about soiling

    Gloves are not a substitute for hand hygiene, which must be performed after glove removal. Alcohol handrub is effective for visibly clean hands, but after contact with body fluids or when soiling is suspected, washing with soap and water is preferred; plain water alone is insufficient.

    Reference: WHO Guidelines on Hand Hygiene in Health Care (2009)