Midwife Licensure Exam Midwifery Pharmacology & Newborn Procedures — Maternal & Child Nutrition Counseling (Midwife-led)Exam Answer Templates

Marks

1

Topic

Maternal Micronutrient Supplementation

Difficulty

easy

Template Id

T1

Examiner Tip

A 1-mark answer must be a complete clinical statement with the exact numerical dose. Vague answers like 'iron and folate tablet daily' will not earn the mark in a rigorous MLE setting.

Model Answer

The recommended daily supplement for a pregnant woman is 60 mg elemental iron plus 400 micrograms (0.4 mg) folic acid, given once daily, started at the first prenatal visit and continued throughout pregnancy and for 3 months postpartum.

Question Type

very_short_answer

Answer Structure

• State the exact elemental iron dose (60 mg) AND folic acid dose (400 mcg / 0.4 mg) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing only 'iron supplement' without the specific dose of 60 mg
• Omitting folic acid from the answer
• Writing 'folic acid' without the dose (400 mcg)

Key Phrases To Include

• 60 mg elemental iron
• 400 micrograms (0.4 mg) folic acid
• once daily
• first prenatal visit
• 3 months postpartum

Marks

1

Topic

Maternal Micronutrient Supplementation

Difficulty

easy

Template Id

T2

Examiner Tip

The examiner wants the specific condition prevented. 'Birth defects' alone is too vague; 'neural tube defects' or naming spina bifida earns the mark.

Model Answer

Folic acid prevents neural tube defects (such as spina bifida and anencephaly) in the developing fetus. It is most protective when taken before conception and during the first trimester when the neural tube closes.

Question Type

very_short_answer

Answer Structure

• Name the condition prevented (neural tube defects) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying folic acid prevents anemia (that is iron's role, not folate's primary role in NTD prevention)
• Not specifying neural tube defects by name

Key Phrases To Include

• neural tube defects
• spina bifida
• anencephaly
• before conception
• first trimester

Marks

2

Topic

Infant and Child Vitamin A

Difficulty

easy

Template Id

T3

Examiner Tip

Vitamin A dosing is the single most frequently tested number in child nutrition. Memorize: 100,000 IU for the younger infant group, double (200,000 IU) twice yearly for 1–5 years. A mnemonic: '6–11 = one capsule half-dose; 12 months and up = full dose twice a year.'

Model Answer

For an infant aged 6–11 months: 100,000 IU of Vitamin A, given as a single dose. For a child aged 12–59 months (1–5 years): 200,000 IU of Vitamin A, given once every 6 months (twice yearly, during Garantisadong Pambata rounds).

Question Type

very_short_answer

Answer Structure

• Line 1: State 100,000 IU for 6–11 months [1 mark]
• Line 2: State 200,000 IU every 6 months for 12–59 months [1 mark]

Scoring Breakdown

Common Mark Deductions

• Reversing the doses (giving 200,000 IU to the 6–11 month group) — very common and loses both marks
• Omitting the frequency 'every 6 months' for the 12–59 month group
• Not stating that Vitamin A is NOT routinely given below 6 months

Key Phrases To Include

• 100,000 IU
• 6–11 months
• 200,000 IU
• 12–59 months
• every 6 months
• Garantisadong Pambata

Marks

2

Topic

Maternal Micronutrient Supplementation — Vitamin A

Difficulty

medium

Template Id

T4

Examiner Tip

Always pair the contraindication with the correct alternative. Examiners reward answers that show you know WHAT to do instead, not just what to avoid.

Model Answer

High-dose Vitamin A (such as the 200,000 IU postpartum capsule) is teratogenic — it can cause serious birth defects in the developing fetus, particularly affecting the heart, skull, and central nervous system. Therefore, the midwife must never administer a high-dose Vitamin A capsule to a woman who is pregnant or who may become pregnant. The postpartum dose is given only to the mother in the early postpartum period (within approximately the first 4 weeks while still lactating and amenorrheic).

Question Type

short_answer

Answer Structure

• Line 1: State the risk — 'teratogenic' / causes birth defects [1 mark]
• Line 2: State the correct alternative — when and to whom the postpartum dose is given [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying only 'it is harmful' without using the word 'teratogenic' or specifying birth defects
• Not mentioning when the correct dose is given (postpartum)

Key Phrases To Include

• teratogenic
• birth defects
• contraindicated in pregnancy
• postpartum
• lactating mother
• 200,000 IU

Marks

2

Topic

Exclusive Breastfeeding — Positioning and Latch

Difficulty

easy

Template Id

T5

Examiner Tip

Enumerate means list in order. Number each sign clearly. Examiners give one mark for every correct sign, so every sign you omit is a direct mark lost.

Model Answer

The four signs of a good latch are: 1. More areola is visible above the baby's mouth than below. 2. The baby's mouth is wide open. 3. The baby's lower lip is turned outward (everted). 4. The baby's chin is touching the breast.

Question Type

short_answer

Answer Structure

• List all four observable signs of correct latch [½ mark each, total 2 marks]

Scoring Breakdown

Common Mark Deductions

• Listing only 2–3 signs and not all four
• Describing the latch from the mother's comfort perspective only (e.g., 'no pain') without the clinical signs
• Confusing 'more areola above' with 'more areola below' — exact opposite and loses the mark

Key Phrases To Include

• more areola visible above
• mouth wide open
• lower lip turned outward / everted
• chin touching the breast

Marks

3

Topic

Exclusive Breastfeeding — LAM

Difficulty

medium

Template Id

T6

Examiner Tip

The word 'all three' is magic in a LAM answer — it signals clinical competence. Examiners also reward you for stating what to do when a condition fails (i.e., shift to another FP method).

Model Answer

For LAM to be an effective temporary contraceptive method, ALL three of the following conditions must be met simultaneously: 1. The baby is less than 6 months old. 2. The mother is exclusively breastfeeding (breast milk only, no other foods or liquids, day and night). 3. The mother's menstrual period has not yet returned (she is still amenorrheic). If any ONE of these conditions is no longer met, LAM is no longer reliable, and the woman should be counseled to start another family-planning method.

Question Type

short_answer

Answer Structure

• Condition 1: Baby under 6 months old [1 mark]
• Condition 2: Exclusive breastfeeding (no other food/liquid) [1 mark]
• Condition 3: Menses have not returned (amenorrheic) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing only 2 of the 3 conditions
• Not specifying 'exclusively' breastfeeding — 'breastfeeding' alone is insufficient
• Omitting the counseling action when one condition is no longer met

Key Phrases To Include

• baby less than 6 months
• exclusively breastfeeding
• amenorrheic / menses not returned
• all three conditions simultaneously
• start another family-planning method if any condition fails

Marks

3

Topic

Breastfeeding — Common Problems

Difficulty

medium

Template Id

T7

Examiner Tip

A scenario question expects a cause AND a counseling plan AND a referral condition. Answers that only list one of these three earn partial marks. Structure your answer with numbered points to show the examiner you are covering all dimensions.

Model Answer

Most likely cause: Poor breastfeeding attachment (incorrect latch). Counseling: 1. Explain that sore and cracked nipples are almost always caused by the baby not latching on correctly, not by milk supply problems. 2. Demonstrate and help her achieve a correct latch — the baby's mouth should be wide open, more areola visible above than below, lower lip everted, and chin touching the breast. 3. Advise her to apply a few drops of her own hindmilk to the nipple after each feed and allow it to air-dry, as breast milk has natural healing properties. 4. Encourage her to continue breastfeeding frequently; stopping will worsen engorgement and reduce milk supply. 5. If the nipples are severely damaged or infected (mastitis signs: redness, warmth, fever), refer to a physician.

Question Type

short_answer

Answer Structure

• Sentence 1: Identify the cause — poor attachment / incorrect latch [1 mark]
• Sentences 2–4: Give at least 2 correct counseling interventions (correct latch, hindmilk, continue feeding) [1 mark each]
• Sentence 5: State referral trigger (signs of mastitis/infection) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'stop breastfeeding to let nipples heal' — this is wrong and shows poor understanding
• Not identifying incorrect latch as the cause
• Omitting the referral trigger for mastitis

Key Phrases To Include

• poor attachment / incorrect latch
• correct the latch
• apply hindmilk
• continue breastfeeding
• refer if signs of mastitis

Marks

3

Topic

Exclusive Breastfeeding — RA 10028

Difficulty

medium

Template Id

T8

Examiner Tip

Philippine law citations signal professional knowledge. Memorize: RA 10028 = promotion of breastfeeding; EO 51 = Milk Code (no formula ads); RA 7600 = rooming-in. One correct citation earns a full mark.

Model Answer

Exclusive breastfeeding means giving the infant breast milk only — with no other food, drink, or water — for the first 6 completed months of life. Even in a hot climate, no water is needed. Breastfeeding should be initiated within the first hour after birth (as per EINC/Unang Yakap) and continued along with appropriate complementary foods up to 2 years of age and beyond. The governing Philippine law is RA 10028 (Expanded Breastfeeding Promotion Act of 2009), which promotes and supports breastfeeding and requires lactation stations and lactation breaks in workplaces. It builds on EO 51 (the Milk Code), which prohibits promotion of breast-milk substitutes, and RA 7600 (the Rooming-In and Breast-Feeding Act), which mandates rooming-in of newborns.

Question Type

short_answer

Answer Structure

• Sentence 1: Define exclusive breastfeeding — breast milk only, no water, no other food [1 mark]
• Sentence 2: State the duration — 6 months exclusive, continue to 2 years with complementary food [1 mark]
• Sentence 3: Cite RA 10028 and at least one supporting law (EO 51 or RA 7600) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'no other food' but not explicitly saying 'no water' — the no-water component is a frequent MLE trap
• Citing RA 7600 for breastfeeding promotion when RA 10028 is the primary law
• Not mentioning the 2-year continuation goal

Key Phrases To Include

• breast milk only
• no water
• 6 completed months
• initiate within first hour
• continue to 2 years
• RA 10028
• EO 51 Milk Code
• RA 7600

Marks

3

Topic

Complementary Feeding

Difficulty

medium

Template Id

T9

Examiner Tip

The MLE often uses the phrase 'timely, adequate, safe, and properly fed' — the four principles of complementary feeding. Mentioning these four words signals a high-level answer and may earn additional credit.

Model Answer

Complementary feeding should begin at 6 completed months of age, while continuing to breastfeed. Breast milk alone is no longer sufficient to meet the growing infant's energy and nutrient needs after 6 months. At 6–8 months: 1. Frequency: Offer 2–3 meals per day, starting with soft, mashed, energy-dense foods, introducing one new food at a time. 2. Food type: Include iron-rich and animal-source foods (such as egg, fish, meat, and liver), plus fruits and vegetables, with a small amount of added fat or oil for energy. Avoid feeding bottles, sugary drinks, and tea.

Question Type

short_answer

Answer Structure

• Sentence 1: State 6 completed months as the start age [1 mark]
• Point 1: Frequency — 2–3 meals per day [1 mark]
• Point 2: Food type — iron-rich and animal-source foods, soft and mashed [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'start at 4 months' or 'start at 6–8 months' — 6 completed months is the exact answer
• Not mentioning that breastfeeding continues alongside complementary feeding
• Omitting iron-rich foods from the food type answer

Key Phrases To Include

• 6 completed months
• breastfeeding continues
• 2–3 meals per day
• soft, mashed, energy-dense
• iron-rich and animal-source foods
• egg, fish, meat, liver

Marks

5

Topic

Growth Monitoring at the BHS

Difficulty

hard

Template Id

T10

Examiner Tip

A 5-mark answer must have at least 5 distinct, clearly separated points — use a numbered or paragraph structure. The examiner is looking for clinical depth: the MUAC cut-off, the curve direction concept, and referral criteria are the three elements that separate a 3-mark answer from a 5-mark answer.

Model Answer

Growth monitoring and promotion (GMP) is a routine midwife-led activity typically conducted monthly for infants and at each child health visit at the BHS. Steps in growth monitoring: 1. Weigh the child accurately using a properly calibrated scale. Measure length (for children under 2 years) or height (for children 2 years and above). 2. Plot the weight (and length/height) on the Growth Monitoring Chart or the WHO Child Growth Standards card in the Mother-Child Book. 3. Interpret the DIRECTION of the growth curve, not just a single weight. A flat or falling growth curve is an early warning sign of undernutrition, even before the child falls below the standard weight-for-age line. 4. Classify nutritional status: normal, underweight, or severely underweight based on weight-for-age; and assess Mid-Upper Arm Circumference (MUAC) for acute malnutrition in children 6–59 months. 5. Use each weighing session as a counseling opportunity — advise the mother on feeding practices, emphasize breastfeeding continuation, and promote timely introduction and variety of complementary foods. 6. Provide scheduled interventions: Vitamin A supplementation per age-group dose and twice-yearly deworming (albendazole 400 mg; 200 mg for children 12–23 months). 7. Check and update immunization status. Referral criteria: — A child with a MUAC less than 11.5 cm (severe acute malnutrition) — A child with bilateral pedal edema (sign of kwashiorkor) — A child who is severely underweight or shows persistent weight faltering despite counseling — These children must be referred to a physician or therapeutic feeding program for management that is beyond the midwife's scope. Growth monitoring is not only about detecting malnutrition — it is a positive, empowering interaction where the midwife and mother together take action at the first sign of faltering.

Question Type

long_answer

Answer Structure

• Paragraph 1: Introduction — what GMP is and how often it is done [1 mark]
• Paragraph 2: Steps 1–3 — weighing, plotting on chart, interpreting direction of curve [1 mark]
• Paragraph 3: Steps 4–5 — classification (MUAC), counseling [1 mark]
• Paragraph 4: Steps 6–7 — Vitamin A, deworming, immunization [1 mark]
• Paragraph 5: Referral criteria — MUAC <11.5 cm, bilateral edema, severe underweight [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing only a single weight measurement without mentioning the importance of the growth trend/curve direction
• Omitting the MUAC cut-off of 11.5 cm
• Writing 'manage malnutrition' instead of 'detect and refer' — outside midwife scope
• Not stating the correct deworming dose adjustment for children 12–23 months (200 mg, not 400 mg)
• Failing to connect growth monitoring to counseling and health promotion

Key Phrases To Include

• growth monitoring and promotion (GMP)
• Mother-Child Book / WHO Child Growth Standards
• direction of the growth curve
• flat or falling line
• MUAC less than 11.5 cm
• bilateral pedal edema
• refer to physician / therapeutic feeding program
• albendazole 400 mg (200 mg for 12–23 months)
• Vitamin A per age-group dose

Marks

5

Topic

Maternal Micronutrient Supplementation — Iron-Folic Acid Counseling

Difficulty

hard

Template Id

T11

Examiner Tip

Case-study questions at the 5-mark level want comprehensive counseling, not just drug information. The examiner is checking that you can advise on why, how, how long, what to expect (side effects), and when to escalate — all five dimensions earn one mark each.

Model Answer

Iron–folic acid counseling for this pregnant woman: 1. What to take: She should take one tablet of ferrous sulfate (containing 60 mg elemental iron) plus 400 micrograms (0.4 mg) folic acid every day, once daily. In some health centers this is dispensed as a combined iron–folate tablet. 2. Why it is important: Iron prevents and treats iron-deficiency anemia, which is common in Filipino pregnant women and which increases the risk of preterm birth, low birth weight, and maternal death from postpartum hemorrhage. Folic acid prevents neural tube defects (spina bifida, anencephaly) in the baby — it is most effective in the first trimester. 3. How long to take it: She should start now (first prenatal visit) and continue every day throughout pregnancy and for 3 months after delivery (postpartum). 4. How to take it for best absorption: Take the tablet on an empty stomach or with a Vitamin-C-rich food (like calamansi juice or tomato) to improve iron absorption. Avoid taking it with tea, coffee, or milk, which reduce absorption. 5. Expected side effects: Black or dark-green stools are normal and expected with iron — reassure her this is not a sign of bleeding. Some women experience mild nausea or constipation; advise to take with food if nausea occurs and to eat high-fiber foods and drink plenty of water. 6. Adherence counseling: Emphasize taking the tablet every day without skipping. If anemia is confirmed (pallor, hemoglobin below 11 g/dL), the dose may be doubled to twice daily per protocol, and she will be referred to the RHU physician for evaluation. 7. Supply and follow-up: Dispense a 1-month supply and schedule the next prenatal visit. Document the supplement given in her Mother-Child Book.

Question Type

case_study

Answer Structure

• Point 1: Correct drug, dose, and frequency (60 mg iron + 400 mcg folate, once daily) [1 mark]
• Point 2: Rationale — anemia prevention and neural tube defect prevention [1 mark]
• Point 3: Duration — first prenatal visit through pregnancy and 3 months postpartum [1 mark]
• Point 4: Administration counseling — take with Vit-C food, avoid tea/coffee; black stools are normal [1 mark]
• Point 5: Referral/escalation — double dose and refer if diagnosed anemia; document and follow up [1 mark]

Scoring Breakdown

Common Mark Deductions

• Not specifying the elemental iron dose (just saying 'ferrous sulfate' without 60 mg)
• Omitting the 3-month postpartum continuation
• Failing to include the drug interaction counseling (Vit C vs. tea/coffee)
• Not addressing side effects (black stools reassurance) — patients often stop taking iron due to alarm over dark stools
• Writing 'manage anemia' instead of 'refer if severe anemia'

Key Phrases To Include

• 60 mg elemental iron
• 400 micrograms folic acid
• once daily
• throughout pregnancy and 3 months postpartum
• Vitamin C improves absorption
• tea and coffee reduce absorption
• black stools are normal
• neural tube defects
• refer if severe anemia
• Mother-Child Book

Marks

1

Topic

Iodine and the ASIN Law

Difficulty

easy

Template Id

T12

Examiner Tip

Philippine nutrition laws are a common MLE topic. Match the law to its nutrient: RA 8172 = iodine (salt); RA 8976 = food fortification (iron-fortified rice, etc.). This pairing prevents confusion.

Model Answer

RA 8172, known as the ASIN Law (Act for Salt Iodization Nationwide), mandates the iodization of all salt sold and used in the Philippines. Its purpose is to prevent iodine-deficiency disorders, including goiter, hypothyroidism, and cretinism (severe brain damage in infants born to iodine-deficient mothers).

Question Type

very_short_answer

Answer Structure

• State what RA 8172 requires (iodized salt) AND the deficiency it prevents (iodine deficiency / goiter) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Confusing RA 8172 with RA 8976 (Food Fortification Law — which covers iron-fortified rice and other foods)
• Saying 'prevents anemia' — anemia is linked to iron, not iodine

Key Phrases To Include

• RA 8172
• ASIN Law
• salt iodization
• iodine-deficiency disorders
• goiter
• cretinism

Marks

2

Topic

Exclusive Breastfeeding — No Water Rule

Difficulty

medium

Template Id

T13

Examiner Tip

The phrase 'even in hot weather, no water is needed' is a classic MLE trap statement. The examiner expects you to confidently say NO and back it up with the physiology (breast milk hydration) or policy (RA 10028). Uncertainty in this answer will lose you both marks.

Model Answer

I will reassure the mother that her 3-month-old baby does not need water, even in hot weather. Breast milk is composed of approximately 88% water and fully meets the baby's fluid needs. Giving water before 6 months: 1. Reduces the baby's hunger and decreases the frequency of breastfeeding, which in turn reduces the mother's milk supply. 2. May introduce pathogens and cause diarrhea. 3. Violates the principle of exclusive breastfeeding (breast milk only for the first 6 months — no water, no other drinks). I will encourage the mother to breastfeed more frequently on demand if the baby seems thirsty in the heat. This practice is protected under RA 10028 and EO 51 (the Milk Code).

Question Type

short_answer

Answer Structure

• Sentence 1: Clearly tell the mother NO water is needed — breast milk is sufficient even in heat [1 mark]
• Sentence 2: Explain why — one valid reason (breast milk has enough water content, or giving water reduces milk supply/introduces infection) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Saying 'it is okay to give a little water' — this is incorrect and dangerous for EBF
• Not explaining why water is harmful or unnecessary
• Failing to counsel the correct action (breastfeed more frequently on demand)

Key Phrases To Include

• no water needed
• breast milk only
• exclusive breastfeeding
• breast milk is sufficient even in hot weather
• reduces breastfeeding frequency
• 6 months

Marks

2

Topic

Deworming and Nutrition Programs

Difficulty

medium

Template Id

T14

Examiner Tip

The dose adjustment for 12–23 months (200 mg vs. the standard 400 mg) is a high-yield MLE point because giving the wrong dose to a young child is a clinical safety issue. Examiners reward precision here.

Model Answer

Under the DOH deworming program, children are given albendazole twice yearly (every 6 months), usually alongside the Vitamin A distribution rounds: 1. Children 12–23 months (1–2 years): Albendazole 200 mg, given twice yearly. 2. Children 24–59 months (2–5 years): Albendazole 400 mg, given twice yearly. Note: Deworming is NOT given to children below 12 months. Pregnant women may be dewormed with albendazole after the first trimester (second and third trimester) per DOH protocol.

Question Type

short_answer

Answer Structure

• State 200 mg for 12–23 months [1 mark]
• State 400 mg for 24 months and above / twice yearly [1 mark]

Scoring Breakdown

Common Mark Deductions

• Giving 400 mg to a 13-month-old child — the reduced dose for 12–23 months is the most commonly missed exam point
• Omitting the frequency (twice yearly)
• Not mentioning that deworming is contraindicated below 12 months

Key Phrases To Include

• albendazole
• 200 mg for 12–23 months
• 400 mg for 24 months and above
• twice yearly (every 6 months)
• after first trimester for pregnant women

Marks

3

Topic

Growth Monitoring — Severe Acute Malnutrition and Referral

Difficulty

hard

Template Id

T15

Examiner Tip

MUAC 11.5 cm is the most important single number in child nutrition for the MLE. Write it boldly in your answer. The detect-and-refer framing is mandatory — any answer that tries to 'manage' SAM at BHS level will lose a mark for scope of practice.

Model Answer

Finding: A MUAC (Mid-Upper Arm Circumference) of 11.0 cm in a child aged 6–59 months is below the cut-off of 11.5 cm. This indicates SEVERE ACUTE MALNUTRITION (SAM). The midwife's action: 1. Confirm the finding — re-measure the MUAC, check for bilateral pedal edema (a sign of kwashiorkor), and assess clinical signs (visible severe wasting, loss of subcutaneous fat, hair changes). 2. Inform the mother of the findings calmly and explain the need for immediate medical evaluation. 3. REFER immediately to a physician at the RHU or hospital for assessment and enrollment in a Therapeutic Feeding Program (TFP) or Outpatient Therapeutic Program (OTP). This is beyond the midwife's scope of independent management. 4. While awaiting referral, reinforce breastfeeding and appropriate feeding, and ensure Vitamin A has been given per schedule (100,000 IU for this 7-month-old child). 5. Document the MUAC measurement, referral, and counseling given in the child's records.

Question Type

case_study

Answer Structure

• Sentence 1: Interpret MUAC 11.0 cm as Severe Acute Malnutrition (SAM) — below cut-off of 11.5 cm [1 mark]
• Sentence 2–3: Confirm finding and check for bilateral edema [1 mark]
• Sentence 4–5: REFER to physician/RHU/hospital / Therapeutic Feeding Program; document [1 mark]

Scoring Breakdown

Common Mark Deductions

• Not knowing the MUAC cut-off of 11.5 cm
• Writing 'manage with nutritional supplements at BHS level' without referral — incorrect scope of practice
• Omitting bilateral edema check
• Failing to document

Key Phrases To Include

• MUAC less than 11.5 cm
• severe acute malnutrition (SAM)
• bilateral pedal edema
• refer to physician / RHU / hospital
• Therapeutic Feeding Program
• beyond midwife's scope to manage independently
• document findings