🎯 High-Yield Points for This Topic
- Fetal distress (late decelerations, bradycardia) requires immediate repositioning, oxygen, and notification
- Uterine atony is the leading cause of postpartum haemorrhage — fundal massage is the immediate first action
- Severe pre-eclampsia (BP ≥160/110 with symptoms) is an emergency requiring magnesium sulfate and urgent referral
- Neonatal resuscitation follows a strict sequence: dry/stimulate/position airway → PPV → chest compressions only if HR <60
- Postpartum unilateral leg pain/swelling suggests DVT — never massage the affected leg
[Infographic: NCK Midwifery Key Concepts — Labour, Emergencies, Neonatal Care]
Practice Questions
['Question 1
A woman at 38 weeks gestation arrives in active labour. On vaginal examination, the cervix is 8 cm dilated. Which finding would require IMMEDIATE intervention?
✓ Correct: Fetal heart rate of 90 beats per minute with late decelerations
A fetal heart rate of 90 bpm with late decelerations indicates fetal distress, likely from uteroplacental insufficiency. This requires immediate intervention: reposition the mother to left lateral, give oxygen, stop oxytocin if running, and notify the obstetric team urgently. The other findings are normal for active labour.
A fetal heart rate of 90 bpm with late decelerations indicates fetal distress, likely from uteroplacental insufficiency. This requires immediate intervention: reposition the mother to left lateral, give oxygen, stop oxytocin if running, and notify the obstetric team urgently. The other findings are normal for active labour.
Question 2
Two hours after a vaginal delivery, a woman\'s fundus is soft and boggy, and she has heavy vaginal bleeding. What is the nurse-midwife\'s FIRST action?
✓ Correct: Massage the fundus firmly
A soft, boggy fundus with heavy bleeding indicates uterine atony, the most common cause of postpartum haemorrhage. Fundal massage stimulates uterine contraction and is the immediate first-line action, performed simultaneously with calling for help — not instead of it.
A soft, boggy fundus with heavy bleeding indicates uterine atony, the most common cause of postpartum haemorrhage. Fundal massage stimulates uterine contraction and is the immediate first-line action, performed simultaneously with calling for help — not instead of it.
Question 3
A pregnant woman at 34 weeks presents with a blood pressure of 162/108 mmHg, severe headache, and visual disturbances. Which condition should the midwife suspect?
✓ Correct: Severe pre-eclampsia
Blood pressure ≥160/110 mmHg with headache and visual disturbance after 20 weeks gestation meets criteria for severe pre-eclampsia, a hypertensive emergency that can progress to eclampsia (seizures). This requires urgent assessment, magnesium sulfate per protocol, and urgent referral.
Blood pressure ≥160/110 mmHg with headache and visual disturbance after 20 weeks gestation meets criteria for severe pre-eclampsia, a hypertensive emergency that can progress to eclampsia (seizures). This requires urgent assessment, magnesium sulfate per protocol, and urgent referral.
Question 4
Immediately after birth, a newborn is not breathing and has a heart rate of 80 beats per minute. What is the FIRST action in neonatal resuscitation?
✓ Correct: Dry, dry, stimulate, and position the airway, then provide positive pressure ventilation if needed
The Helping Babies Breathe / neonatal resuscitation algorithm begins with drying, stimulating, and positioning the airway. If the baby remains apnoeic or heart rate stays below 100 bpm, positive pressure ventilation is initiated immediately. Chest compressions are reserved for heart rate below 60 bpm despite adequate ventilation.
The Helping Babies Breathe / neonatal resuscitation algorithm begins with drying, stimulating, and positioning the airway. If the baby remains apnoeic or heart rate stays below 100 bpm, positive pressure ventilation is initiated immediately. Chest compressions are reserved for heart rate below 60 bpm despite adequate ventilation.
Question 5
A woman who delivered 6 hours ago reports sudden, severe, one-sided calf pain and swelling. What should the midwife suspect and do FIRST?
✓ Correct: Possible deep vein thrombosis; assess further and notify the physician, avoid massaging the leg
Unilateral calf pain and swelling postpartum is a classic sign of deep vein thrombosis, a known risk in the postpartum period due to hypercoagulability. The leg should never be massaged (risk of dislodging a clot) and the physician must be notified promptly for assessment and possible anticoagulation.
Unilateral calf pain and swelling postpartum is a classic sign of deep vein thrombosis, a known risk in the postpartum period due to hypercoagulability. The leg should never be massaged (risk of dislodging a clot) and the physician must be notified promptly for assessment and possible anticoagulation.
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Access Full Question Bank — Ksh 5,000Key Nursing Concepts: NCK Midwifery
Midwifery questions on the NCK exam test recognition of normal versus abnormal labour progress, prompt identification of obstetric emergencies, and safe, sequence-correct neonatal care. Partograph interpretation and emergency response sequencing are particularly high-yield areas.
[Clinical Concept Map: Midwifery — Antenatal, Intrapartum, Postnatal, Neonatal]
Frequently Asked Questions
Is midwifery tested on both KRCHN and BScN papers? ⌄
Yes. Midwifery is one of the core subjects for KRCHN candidates and is also covered within the broader BScN curriculum, though BScN candidates may face more complex obstetric scenarios.
What's the most commonly missed topic in NCK midwifery questions? ⌄
Partograph interpretation and the correct sequence of steps in obstetric emergencies (e.g. shoulder dystocia, postpartum haemorrhage) are commonly missed because they require applied, stepwise reasoning rather than simple recall.