Free NMC Test of Competence OSCE: Midwifery Exam Questions and Answers

You are working on the antenatal assessment unit and you have been asked to assess a woman, Amy Hall, who has just presented unannounced with a vaginal bleed at term. The midwife in charge informs you that the woman is 38 weeks pregnant with her second pregnancy. The woman is reporting a small amount of fresh red blood loss vaginally as well as abdominal pain, and 'looks in pain' on admission. You are required to take a full history, complete a full antenatal assessment and perform any additional clinical checks, such as assessing maternal vital signs and fetal wellbeing, according to the findings from her history. Please note that urinalysis and a Cardiotocograph (CTG) have already been performed, with results below. You are required to verbally identify to the examiner any observations which are a cause for concern. Depending on Amy's circumstances and condition, you may wish to focus on some areas of assessment in more depth than others. Please ask the examiner for the information from the full antenatal assessment and any other clinical information you require. An observation chart is provided and must be completed within the station. This document must be completed using a BLUE PEN. You have 20 minutes to complete this station, including the completion of the following documentation: modified early obstetric warning score (MEOWS) chart. Assume it is TODAY and it is 10:30 hours.

Type your answer, then reveal.

You have conducted the following assessment of Amy Hall. Full clinical history: • History of postnatal depression, unexplained infertility and IVF. • Gravida 2 para 1 - previous uneventful pregnancy and spontaneous vaginal delivery at term. • Current pregnancy - Originally consultant care, history of low-lying placenta at 20 weeks, normal placental position and fetal growth at 24 weeks, transferred to midwife-led care at 34 weeks. • Currently 38 weeks, small post-coital bleed, fresh red blood loss on wiping with no active bleeding, intermittent abdominal pain. o Sexual intercourse at 7.30am this morning. o Intermittent abdominal pain since 8.30am this morning. o Small fresh red blood loss noted on wiping and staining of underwear at 9.30am this morning. Assessment of maternal wellbeing: • Temperature: 36.6°C • Heart rate: 88 bpm • Blood pressure: 120/60 • Oxygen saturations: 100% • Urinalysis: 150mls volume +++ blood ++ leucocytes • Alert, fit and well • Pain level 2/3. Abdominal palpation: • Abdomen soft and non-tender • Mild uterine contractions noted 1:3-5 lasting 30 seconds • Fundal height = 38cms, longitudinal lie, cephalic presentation 3/5 palpable. Assessment of fetal wellbeing: • Normal fetal movements • Fetal heart auscultated with Pinard - 146 bpm • Cardiotocograph performed because of fresh vaginal bleed. CTG findings reassuring. Diagnosis: • Small post-coital vaginal bleed and irregular uterine contractions. Differential diagnosis: • Early labour with blood-stained show. Based on your assessment of Amy Hall, please produce a midwifery care plan for the next 4 hours. Include relevant information from your assessment. This is a silent written station. Please ensure that you write legibly and clearly. You do not need to write a report. You can use bullet points to summarise what you would do. You have 14 minutes to complete this station. Assume it is TODAY and it is 11:30 hours.

Type your answer, then reveal.

Amy Hall has now been reviewed by Dr Gupta, following her admission to the antenatal assessment unit with a post-coital vaginal bleed at 38 weeks' gestation. A speculum examination was performed by Dr Gupta where fresh red blood loss was seen on examination. The cervical os was reported to be short and approximately 1-2cms dilated. Intermittent abdominal pain continues. Dr Gupta has requested that Amy Hall be admitted to the antenatal ward for observation of her vaginal loss and abdominal pain overnight. Medications required for this admission are prescribed by Dr Gupta. Dr Gupta asks that all required medications due at 14:00 hours are to be administered prior to transfer to the antenatal ward. Please administer and document all required 14:00 hours medications for Amy Hall in a safe and professional manner. • During this station, you should communicate with Amy. • Please verbalise what you are doing and why to the examiner. • Read out the chart and explain what you are checking/giving/not giving and why. • Explain to Amy what each drug being administered is for, and highlight any specific information regarding instructions for administration, including any possible contraindications, side effects and relevant medical information. • Complete all the required drug administration checks. • Complete the documentation and use the correct codes. • The correct codes for non-administration are on the chart. • Check and complete the last page of the chart. You have 15 minutes to complete this station, including all the required documentation. Complete all sections of the document. Assume it is TODAY and it is 14:00 hours.

Type your answer, then reveal.

Scenario: You are a midwife now working on the antenatal ward. Amy Hall has had an uneventful night on the antenatal ward. Amy has not experienced any further vaginal blood loss overnight and her abdominal pain has now settled. You have carried out an antenatal assessment of Amy this morning. A CTG was also carried out to assess fetal wellbeing, and both assessments are reassuring. Dr Gupta has also reviewed Amy this morning and has discharged Amy back to midwifery-led care in the community. You are required to provide a verbal handover to ensure that the community midwife has a full and accurate account of Amy's history and ongoing care needs. This is a verbal station, but you will have the opportunity to make notes to support your answer. Using the situation, background, assessment and recommendation (SBAR) tool, please make notes regarding Amy and use them to complete a verbal handover to the antenatal ward midwife on the next shift (the examiner). Please discuss any further care needs or actions the midwife may need to consider in the next 24 to 48 hours. Your documentation from your assessment, planning and implementation stations is available for you to refer to, but you must not write on any of them. You have 8 minutes in total to make notes (which are not assessed) and complete the verbal handover to the examiner (which is assessed). You will be informed when there are 2 minutes remaining. Assume it is TODAY and it is 10:00 hours.

Type your answer, then reveal.

Overview: Systematic examination of the newborn Scenario You are working on a labour ward. You have been asked to assist with the care of Helen, who gave birth to her second baby 6 hours ago. Helen and her baby are fit and well postnatally, and Helen would like an early postnatal discharge home. You have been asked to perform the systematic examination of the newborn prior to Helen's discharge home. The midwife caring for Helen informs you of Helen's clinical history as follows. Helen opted to have full antenatal screening for fetal anomaly at 16 weeks, which were reported to be low risk. At 20 weeks, Helen opted to have a fetal anomaly scan, where the nuchal fold was reported to be 6mm with no further anomalies noted. Helen declined further follow-up. Helen was admitted in spontaneous labour and was in labour for 7 hours. Helen had an uncomplicated vaginal delivery of a live male infant. No resuscitation was required at birth. An examination of the infant at birth was performed and no abnormalities were detected. You have 25 minutes to complete this station including all the required documentation. You will be informed when there are 5 minutes remaining. - Please undertake a complete examination of the newborn. - Please verbalise and demonstrate your actions throughout the examination, giving careful consideration to evidence-based practice and newborn guidance. - Of the four key areas (eyes, heart, hips, testes), focus in more depth on the two key areas selected by the examiner. For these key areas only, please provide a more in-depth assessment and verbalise potential referral pathways. - The systematic examination of the newborn offers an opportunity for parent education and health promotion. Please explain the purpose of the screening programme. You should include key information and advice as part of your examination. Please record your findings and any relevant referrals in the document provided. All the equipment you need is provided and has already been calibrated.

Type your answer, then reveal.

You are working on a busy postnatal ward. One of the women you are caring for is Miriam, who birthed twin boys at 33 weeks gestation 2 days ago. The babies are doing well in the neonatal intensive care unit. Miriam calls her bell and, when you arrive, she is very distressed and angry. She tells you that she feels pressured into expressing breastmilk for her babies and she wants to stop. Miriam's husband is with her and he is upset as he is concerned that the babies need expressed breastmilk due to their early gestational age. Using your knowledge of NMC (2018) 'The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates', consider the professional, ethical and legal implications of this situation. Please summarise the actions that you would take in a number of bullet points. This is a silent written station. Please write clearly and legibly. You have 10 minutes to complete this station.

Type your answer, then reveal.

You are working in the community and have an appointment with Hana, who is 36 weeks pregnant with her second baby. She had a ventouse delivery last time and has been reading about how to prevent perinea! trauma during birth. She wants to talk to you about whether the midwife or obstetrician can manually protect her perineum at the end of the second stage of labour to prevent trauma. Article summary: An interventional cohort study published in 2010 was used as evidence to support the Royal College of Obstetricians and Gynaecologists' (RCOG) OASI care bundle, which is supported in UK practice by the Royal College of Midwives. The study involved the application of an intervention in 40,152 vaginal deliveries in Norway between 2003 and 2009. The intervention was manual support of the perineum at the end of the second stage of labour. The study found that the incidence of anal sphincter injury reduced from 4-5% to 1-2% during the study. The study also found that: • the incidence of perinea! trauma reduced in both instrumental deliveries and spontaneous vaginal deliveries • reduction in fourth-degree tears was the most significant finding of the study • intervention had no harmful effects on the newborn. There were variables regarding episiotomy rates, mode of delivery and parity in different participating hospitals during the study. Read the scenario and the summary of the research. Please identify the main points from the summary and apply the findings to the scenario. What is the relevance of the findings from this research? What advice will you give to Hana? Give your responses here as bullet points. This is a silent written station. You have 10 minutes to complete this task.

Type your answer, then reveal.