Preparing for professional midwifery assessments requires more than memorising textbook definitions. The Nursing and Midwifery Council of Nigeria (NMCN) consistently evaluates your ability to apply obstetric theory to real clinical situations. When studying past papers, candidates often notice that while the specific wording of a scenario changes, the underlying clinical dilemmas appear year after year. Try free NMCN past/practice question.
This guide breaks down 20 NMCN Midwifery & Obstetrics Past Questions to watch out for during your revision. These prompts are drawn from high-frequency core competencies across antenatal care, intrapartum management, obstetric emergencies, and puerperal care. Rather than treating past questions as leaked predictions, use these scenarios to test your diagnostic reasoning, nursing process application, and emergency intervention steps.
For an overall perspective on organising your study calendar across all subjects, consult our 2026 November NMCN Preparation Guide for Nursing Students.
Antenatal Care and High-Risk Pregnancy Scenarios
Antenatal questions evaluate your clinical judgment in detecting risk factors early, interpreting abnormal findings, and educating expectant mothers.
1. Assessment of Hypertensive Disorders in Pregnancy
The Question Pattern: A 28-year-old primigravida at 34 weeks gestation presents with persistent frontal headaches, epigastric pain, visual blurring, and a blood pressure reading of 160/110 mmHg. State the provisional diagnosis, outline immediate nursing priorities, and detail the clinical monitoring required.
Clinical Focus: Differentiating severe pre-eclampsia from mild gestational hypertension. Examiners look for immediate seizure precautions, administration protocols for prescribed anticonvulsants (such as magnesium sulphate), fluid balance management, and readiness for delivery.
2. Management of Antepartum Haemorrhage (Placenta Praevia vs. Placental Abruption)
The Question Pattern: Compare the clinical presentation, emergency nursing interventions, and contraindications in the management of placenta praevia versus abruptio placentae in a 32-week pregnancy.
Clinical Focus: Painless, bright red vaginal bleeding versus painful, dark vaginal bleeding with a tense, woody uterus. Never write that you would perform a digital vaginal examination on an unconfirmed antepartum haemorrhage—this is an automatic red flag in Council marking schemes.
3. Hyperemesis Gravidarum and Fluid-Electrolyte Balance
The Question Pattern: A 19-year-old at 10 weeks gestation presents with intractable vomiting, ketonuria, weight loss, and dry mucous membranes. Develop a 48-hour nursing care plan detailing rehydration, antiemetic therapy, and nutritional rehabilitation.
Clinical Focus: Recognition of Wernicke's encephalopathy risks, electrolyte derangements (hypokalaemia), accurate fluid intake-output recording, and step-down refeeding.
4. Anaemia in Pregnancy
The Question Pattern: Discuss the classification, clinical features, and prophylactic versus therapeutic management of iron-deficiency anaemia and sickle cell crisis during pregnancy in a malaria-endemic region.
Clinical Focus: Routine iron and folic acid supplementation, intermittent preventive treatment for malaria (IPTp), nutritional counseling using locally available foods, and indications for blood transfusion in late gestation.
5. Multiple Gestation and Associated Antenatal Risks
The Question Pattern: Identify the physical and ultrasound signs that confirm twin pregnancy. List five maternal and five foetal complications associated with multifoetal gestations, outlining preventive antenatal advice.
Clinical Focus: Height of fundus exceeding gestational age, multiple foetal poles, risks of preterm labour, polyhydramnios, pre-eclampsia, and malpresentations.
Intrapartum Care and Partograph Application
Intrapartum questions check your competence in monitoring labour progress, identifying dystocia early, and protecting foetal wellbeing.
6. Active Phase Labour Monitoring via the Partograph
The Question Pattern: Given a sample labour record showing cervical dilatation crossing the alert line and approaching the action line, interpret the findings, state the probable causes of delayed progress, and outline the midwife's responsibilities.
Clinical Focus: Understanding the WHO-modified partograph. Candidates must explain the significance of the alert and action lines, foetal heart rate trends, moulding, and uterine contraction frequency and strength.
7. Management of the Normal Third Stage of Labour
The Question Pattern: Describe the physiological mechanisms of placental separation. Detail the three active steps of the Active Management of the Third Stage of Labour (AMTSL) and justify each step.
Clinical Focus: Administration of a uterotonic drug within one minute of birth, controlled cord traction with counter-traction to the uterus, and uterine massage. Precision in describing manual placental checks is essential.
8. Breech Presentation: Mechanisms and Delivery Techniques
The Question Pattern: Outline the diagnosis of a frank breech presentation. Describe the principles of assisted breech delivery, including Lovset's manoeuvre for the arms and the Mauriceau-Smellie-Veit technique for the aftercoming head.
Clinical Focus: Hands-off the breech until the umbilicus is born, preventing head entrapment, avoiding traction on the foetal trunk, and timing of episiotomy.
9. Cephalopelvic Disproportion (CPD) and Obstructed Labour
The Question Pattern: Distinguish between prolonged labour and obstructed labour. Describe the maternal and foetal signs of neglected obstructed labour, including Bandl's ring formation.
Clinical Focus: Pathological retraction ring, maternal dehydration, ketoacidosis, caput succedaneum, severe moulding, and immediate measures to prevent uterine rupture.
10. Care of the Woman in the Second Stage of Labour
The Question Pattern: Detail the signs that confirm full cervical dilatation. Outline the management of maternal pushing efforts, perineal support techniques, and indications for an episiotomy.
Clinical Focus: Avoidance of premature maternal expulsive efforts before full dilatation, gradual delivery of the foetal head to prevent perineal tears, and selective rather than routine episiotomy practice.
Obstetric Emergencies and Complex Scenarios
Emergency questions test rapid decision-making, systematic prioritisation, and safe team communication under pressure.
11. Management of Eclampsia
The Question Pattern: A client in established labour suddenly develops generalized tonic-clonic convulsions. Provide a step-by-step account of your immediate interventions, airway maintenance, pharmacological control, and preparation for delivery.
Clinical Focus: Airway, breathing, circulation (ABC), maintaining lateral tilt to avoid supine hypotension, monitoring for signs of magnesium toxicity (patellar reflex, respiratory rate, urine output), and calcium gluconate as the reversal agent.
12. Postpartum Haemorrhage (PPH)
The Question Pattern: Within 30 minutes of delivery, a multiparous client begins bleeding profusely from the genital tract. State the "4 Ts" of PPH aetiology and write an emergency action protocol for primary PPH due to uterine atony.
Clinical Focus: Tone, Tissue, Trauma, Thrombin. Bimanual uterine compression, aortic compression, rapid fluid resuscitation using wide-bore intravenous cannulae, catheterisation, and secondary uterotonics.
13. Umbilical Cord Prolapse
The Question Pattern: Following spontaneous rupture of membranes, loops of pulsating umbilical cord are visualized at the introitus. Detail the immediate position changes, manual relief of cord compression, and emergency transfer procedure.
Clinical Focus: Knee-chest position or exaggerated Sims position, manual elevation of the presenting part off the cord, avoiding unnecessary cord handling to prevent spasm, and immediate preparation for emergency caesarean section.
14. Shoulder Dystocia
The Question Pattern: After delivery of the foetal head, the "turtle sign" is noted, and the shoulders fail to deliver with gentle downward traction. Explain the emergency sequence of manoeuvres required to deliver the infant safely.
Clinical Focus: Calling for help, stopping maternal pushing, the McRoberts manoeuvre, suprapubic pressure, internal rotational manoeuvres, and avoiding fundal pressure.
15. Rupture of the Uterus
The Question Pattern: A woman in labour with a previous lower segment caesarean scar experiences sudden sharp abdominal pain, cessation of uterine contractions, maternal shock, and recession of the presenting part. Outline the diagnostic features and immediate preoperative resuscitation.
Clinical Focus: Differentiating scar dehiscence from complete uterine rupture, rapid fluid resuscitation, typing and cross-matching blood, and urgent laparotomy preparation.
Postnatal Care, Neonatal Health, and Maternal Infections
The puerperium and newborn period require close surveillance for sepsis, neonatal distress, and maternal mental health disturbances.
16. Neonatal Resuscitation at Birth
The Question Pattern: An infant born at 39 weeks is limp, apnoeic, and has a heart rate of 70 beats per minute. Describe the initial steps of newborn resuscitation, the timing of positive pressure ventilation, and chest compressions.
Clinical Focus: Drying, warming, positioning, clearing the airway only if obstructed, the golden minute of ventilation, evaluating chest rise, and calculating Apgar scores at 1 and 5 minutes.
17. Puerperal Sepsis
The Question Pattern: On day 4 postpartum, a woman reports chills, lower abdominal tenderness, foul-smelling lochia, and a temperature of 39°C. Outline the predisposing factors, common causative organisms, and comprehensive nursing management.
Clinical Focus: Subinvolution of the uterus, high vaginal swabs, empirical broad-spectrum antibiotic administration, Fowler's positioning to promote lochial drainage, and hydration.
18. Prevention of Mother-to-Child Transmission (PMTCT) of HIV
The Question Pattern: Detail the comprehensive antenatal, intrapartum, and postnatal strategies designed to eliminate vertical transmission of HIV, including infant prophylaxis and infant feeding counseling.
Clinical Focus: Maternal antiretroviral therapy (ART) adherence, viral load monitoring, avoiding artificial rupture of membranes when possible, safe cord clamping, infant post-exposure prophylaxis, and exclusive breastfeeding with viral suppression.
19. Breastfeeding Complications: Engorgement, Mastitis, and Abscess
The Question Pattern: Compare breast engorgement and acute infective mastitis regarding their causes, clinical manifestations, preventive measures, and treatment strategies.
Clinical Focus: Proper latch and positioning, warm compresses before feeding, cold packs after feeding, continued lactation during simple mastitis, and surgical drainage indications for breast abscess.
20. Puerperal Mental Health Disorders
The Question Pattern: Differentiate among postpartum blues, postpartum depression, and puerperal psychosis in terms of onset, severity, clinical signs, and family nursing support.
Clinical Focus: Distinguishing self-limiting emotional lability from clinical depression or psychiatric emergency; monitoring safety of the mother and infant; and immediate psychiatric referral for psychosis.
How to Approach Scenario Questions in NMCN Papers
Many candidates lose marks not because they lack knowledge, but because they write unstructured answers. Midwifery marking schemes follow systematic clinical logic. When answering scenario-based questions, follow these principles:
- State the immediate priority first: If a mother is bleeding or seizing, airway protection, position, and haemorrhage control take precedence over detailed record-keeping. State what you would do in the first thirty seconds.
- Use the nursing process structure: Assessment (subjective and objective), Diagnosis, Planning/Goals, Implementation (nursing actions with rationales), and Evaluation.
- Specify drug parameters carefully: When naming medications, explain why the drug is given, the route of administration, and the critical nursing observations associated with it (such as monitoring maternal reflexes during magnesium sulphate administration).
- Do not skip communication and documentation: Always mention reassuring the family, obtaining informed consent where relevant, keeping accurate records, and calling the multidisciplinary team.
Frequently Asked Questions
Are these exact questions taken from upcoming NMCN exams?
No. The NMCN does not release future examination questions. These 20 prompts represent the high-frequency clinical scenarios that repeatedly form the basis of past council essay and objective questions across previous examination cycles.
How many years of past questions should I practice before the exam?
Practicing questions from the past five to ten years provides a thorough overview of recurring concepts. Focus on understanding the clinical rationales behind the answers rather than memorising paragraphs verbatim.
Where should I confirm current clinical guidelines for midwifery practice?
Always verify current drug dosages, partograph protocols, and maternal-child health guidelines through official publications issued by the Nursing and Midwifery Council of Nigeria and the Federal Ministry of Health.