Free Practice Questions for NNC NLEM Midwifery

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Key Facts: NNC NLEM Midwifery Exam

150

Theory MCQs

50 marks

OSPE practical component

50% / 80%

Theory / OSPE pass marks

NPR 4,100

Online examination fee

The NNC NLEM is the national credentialing examination for midwives in Nepal, featuring a 150-item theory MCQ paper (50% pass mark) and a practical OSPE (80% pass mark). Independent practice by OpenExamPrep adapts the four International Confederation of Midwives (ICM) competency categories into scenario-based study questions.

Sample NNC NLEM Midwifery Practice Questions

Try these sample questions to review concepts for the NNC NLEM Midwifery exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1According to the International Confederation of Midwives (ICM) definition, what is the core scope of autonomous practice of a qualified midwife?

A.Care in pregnancy, labour and postpartum, conducting births on her own responsibility

B.Caring only for women with high-risk pregnancies, under direct obstetric supervision

C.Providing antenatal education and counselling but never conducting births independently

D.Performing caesarean sections in rural facilities where no doctors are available

Explanation: Under the ICM definition, a midwife is a responsible and accountable professional who works in partnership with women to give support, care and advice during pregnancy, labour and the postpartum period, conducts births on her own responsibility, and cares for the newborn and infant.

2Under Nepal's Right to Safe Motherhood and Reproductive Health Act, 2075 (2018), which right does every woman have?

A.Mandatory caesarean delivery in an institution for every first birth

B.Emergency obstetric and newborn care, free in government facilities

C.Disclosure of the fetus's sex on request after 12 weeks of gestation

D.Permanent sterilization after the second institutional delivery

Explanation: The Act gives every woman the right to safe motherhood, including emergency obstetric care (basic and comprehensive) and essential and emergency newborn care (Section 3), and requires government health institutions to provide reproductive health services free of charge (Section 32). It also prohibits identifying fetal sex for sex-selective abortion (Section 17).

3Which ethical principle in midwifery practice is upheld when a midwife provides comprehensive, unbiased information about birth positions and honors the woman's informed choice?

A.Paternalism (the provider knows best)

B.Non-disclosure of clinical options

C.Autonomy (respect for informed choice)

D.Strict clinical standardization

Explanation: Autonomy recognizes a woman's right to self-determination and bodily integrity. In Respectful Maternity Care (RMC), midwives provide evidence-based information, engage women in shared decision-making, and respect their birth preferences.

4What is the recommended decontamination procedure for surgical instruments immediately following a delivery before manual cleaning?

A.Immediate immersion in boiling water for 30 seconds

B.Spraying with 70% ethyl alcohol and drying with cotton gauze

C.Washing with cold tap water and detergent without pre-treatment

D.Soaking for 10 minutes in a freshly prepared 0.5% chlorine solution

Explanation: According to national and WHO infection prevention guidelines, immediate decontamination requires soaking used instruments and gloves in a 0.5% chlorine solution for 10 minutes. This rapidly inactivates HBV, HCV, and HIV, making items safer to handle during subsequent cleaning.

5In a birthing center, how should used needles, syringes with attached needles, and broken glass ampoules be disposed of?

A.A puncture-proof, leak-resistant sharps container

B.A plastic bag for general non-infectious waste

C.An open bucket for recyclable paper and plastics

D.A cardboard box collected with municipal waste

Explanation: Contaminated needles, syringes with needles, blades and broken glass ampoules must go into a puncture-resistant, leak-proof sharps container at the point of use, to prevent needle-stick injuries and transmission of bloodborne viruses.

6What should a midwife do when an obstetric emergency exceeds her competence and the facility's capability?

A.Continue managing alone so as not to alarm the family

B.Stabilize, then arrange timely referral to a CEONC facility

C.Discharge the woman with advice to visit a hospital later

D.Wait for an obstetrician to arrive before any intervention

Explanation: Professional codes and the ICM competencies require midwives to recognize the limits of their competence, give emergency first-line care (for example, IV access, uterotonics or magnesium sulfate as protocols allow), and refer promptly to a Comprehensive Emergency Obstetric and Newborn Care (CEONC) facility.

7What is the primary objective of Maternal and Perinatal Death Surveillance and Response (MPDSR) as implemented in Nepal's hospitals?

A.To identify the health worker at fault and take disciplinary action

B.To compile death statistics for the census without facility review

C.To identify, review and respond to deaths to prevent future ones

D.To decide compensation claims for families of women who died

Explanation: MPDSR is a continuous cycle of identification, notification, quantitative/qualitative review, and corrective response aimed at uncovering systemic deficiencies (delays, stockouts, clinical skills) to prevent future maternal and perinatal deaths, functioning in a 'no-blame' culture.

8Which of the following constitutes a core tenet of the 'Three Delays Model' that contributes significantly to maternal mortality in rural Nepal?

A.Delays in diagnosis, referral paperwork, and payment at the facility

B.Delays in ANC booking, iron supplementation, and birth registration

C.Delays in labour onset, cervical dilatation, and placental delivery

D.Delays in deciding to seek, reaching, and receiving care

Explanation: Thaddeus and Maine's Three Delays Model identifies: 1) Delay in the decision to seek care (socioeconomic, cultural, awareness factors); 2) Delay in reaching an appropriate health facility (distance, roads, transport); and 3) Delay in receiving adequate emergency care upon arrival at the facility.

9In counseling a pregnant woman during antenatal care, which technique represents effective interpersonal communication by the midwife?

A.Using active listening, open-ended questions, and summarizing to ensure mutual understanding

B.Speaking rapidly in complex medical terminology to convey clinical authority

C.Directing the client to remain silent while the midwife completes administrative paperwork

D.Providing immediate advice before hearing the woman's concerns or symptoms

Explanation: Effective midwifery communication involves active listening, empathy, open-ended questioning, non-verbal validation, and clarifying understanding through summarization (GATHER counseling approach), empowering the woman and building trust.

10Which of the following disinfectants is considered a high-level disinfectant (HLD) capable of destroying all microorganisms except high numbers of bacterial endospores when items are soaked for 20 minutes?

A.70% isopropyl alcohol solution

B.2% activated glutaraldehyde

C.10% povidone-iodine scrub

D.0.1% benzalkonium chloride

Explanation: A 2% activated glutaraldehyde solution (soaked for 20 minutes at room temperature) achieves High-Level Disinfection (HLD), destroying vegetative bacteria, mycobacteria, viruses, and fungi. Complete chemical sterilization requires prolonged soaking (up to 10 hours).

About the NNC NLEM Midwifery Exam

The National Licensure Examination for Midwives (NLEM) is conducted by the Nepal Nursing Council to license professional midwives in Nepal. While the real exam includes an OSPE practical station and viva, independent practice by OpenExamPrep provides an English-language MCQ study adaptation covering the theoretical and clinical decision-making domains.

Exam sponsor: Nepal Nursing Council. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Part 1: 150 four-option MCQs in 150 minutes covering ICM competency domains (General Competencies 36%, Pre-pregnancy & Antenatal 27%, Labour & Birth 17%, Ongoing Care 20%). Part 2: Objective Structured Practical Examination (OSPE) including clinical scenario stations and viva (maximum 1 hour, 50 marks).

Time Limit

150 minutes (theory) plus an OSPE of up to 1 hour

Passing Score

50% aggregate (theory) and 80% (OSPE)

Exam / Certification Fees

NPR 4,100 online fee (plus NPR 2,000 registration fee upon passing)

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

36% (55 of 150 questions)

General Competencies in Midwifery

Midwifery philosophy, professional ethics, legal framework, communication, counseling, infection prevention, and maternal and child health policies in Nepal.

27% (40 of 150 questions)

Pre-Pregnancy & Antenatal Care

Pre-conception counseling, normal antenatal care, risk assessment, screening for gestational disorders, maternal nutrition, and fetal development.

17% (25 of 150 questions)

Care During Labour & Birth

Physiology of labor, partograph monitoring, pain management, normal delivery, active management of the third stage of labor (AMTSL), and obstetric emergencies.

20% (30 of 150 questions)

Ongoing Care of Women & Newborns

Postnatal care, puerperal complications, essential newborn care, neonatal resuscitation, breastfeeding promotion, and postpartum family planning.

Preparing for the NNC NLEM Midwifery Exam

What You Need to Know

Passing score: 50% aggregate (theory) and 80% (OSPE)
Assessment: Part 1: 150 four-option MCQs in 150 minutes covering ICM competency domains (General Competencies 36%, Pre-pregnancy & Antenatal 27%, Labour & Birth 17%, Ongoing Care 20%). Part 2: Objective Structured Practical Examination (OSPE) including clinical scenario stations and viva (maximum 1 hour, 50 marks).
Time limit: 150 minutes (theory) plus an OSPE of up to 1 hour
Exam / certification fees: NPR 4,100 online fee (plus NPR 2,000 registration fee upon passing) Official sources

Using Our Practice Resources

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NNC NLEM Midwifery: Suggested Study Strategy

1Master the International Confederation of Midwives (ICM) competency domains, paying particular attention to normal physiological childbirth and active management of third stage labour (AMTSL).

2Thoroughly understand partograph plotting and interpretation, including alert and action lines and signs of obstructed labour.

3Review neonatal resuscitation protocols (Helping Babies Breathe / Golden Minute standards) and immediate essential newborn care.

4Study emergency obstetric interventions: management of postpartum hemorrhage (uterotonics, bimanual compression), pre-eclampsia/eclampsia (magnesium sulfate protocol), and sepsis.

Frequently Asked Questions

What is the NLEM in Nepal?

The National Licensure Examination for Midwives (NLEM) is the statutory examination administered by the Nepal Nursing Council (NNC) for graduates of approved midwifery programs to register as licensed midwives.

What is the structure of the NLEM examination?

The examination comprises two components: a 150-item objective theory paper (2.5 hours, 50% pass mark) and a scenario-based Objective Structured Practical Examination (OSPE) including viva (up to 1 hour, 80% pass mark).

How does OpenExamPrep adapt the practical OSPE component?

OpenExamPrep provides an English-language MCQ study adaptation focusing on procedural safety, scenario analysis, clinical decision-making, and rubric knowledge tested in both theory and practical stations.

What core competencies guide the NLEM blueprint?

The blueprint follows the International Confederation of Midwives (ICM) essential competencies adapted to Nepal's health system: general competencies, pre-pregnancy/antenatal care, care during labour and birth, and ongoing care of women and newborns.