Free Orthopaedic Nurse Practice Test
The Orthopaedic Nurse Exam is a comprehensive and challenging assessment for men and women hoping to enter this exciting area of health care. This examination is divided into the following eight content areas: degenerative disease (30%), orthopaedic trauma (21%), sports injuries (15%), neuromuscular/pediatrics/congenital (8%), inflammatory disorders (8%), operative orthopaedics (8%), metabolic bone disease (7%), and orthopaedic oncology (3%).
Another way to look at the orthopaedic nurse exam is in terms of test objectives. One quarter of the exam consists of questions about how to teach self-care to achieve maximum functional capacity. Another quarter is made up of questions about how to select appropriate management strategies for a patient's altered comfort. A third quarter of the questions on the orthopaedic nurse exam has to do with procedures for selecting appropriate measures to prevent, minimize, or alleviate complications. Fifteen percent of the examination consists of questions about how to identify activity and positioning parameters, as well as appropriate assistive devices for a given orthopaedic condition. Finally, five percent of the questions are about how to identify strategies to promote adequate nutrition prophylactically and therapeutically, and another five percent of the questions are about how to select appropriate emotional support strategies in relation to specific orthopaedic problems.
The orthopaedic nurse exam was developed by the Orthopaedic Nurses Certification Board.
ONC® Exam Preparation:
1. Which of the following is a CONTRAINDICATION to bisphosphonate therapy?
2. A patient with a stable fractured sacrum is primarily at increased risk for which of the following?
a. Avascular necrosis
b. Fat embolism
c. Paralytic ileus
d. Deep vein thrombosis
3. A 17-year-old adolescent injures his left knee during a football game. He is in severe pain and the knee has obvious deformity, but the posterior tibial and dorsal pulses are palpable. Which, if any, is the appropriate initial splinting procedure?
a. Leg splinted straight with knee in proper position
b. Knee splinted in position found
c. Knee splinted against opposite knee for stability
d. Knee cushioned but not splinted
4. Which of the following is CONTRAINDICATED for the operative leg following hip replacement surgery?
c. Hip flexion 90
d. External rotation
5. Following total knee replacement, a 50-year-old male's leg is placed in a continuous passive motion (CPM) device with initial settings at 10 degrees extension and 50 degrees flexion. What is the usual extension/flexion goal for discharge?
a. 10 degrees extension, 70 degrees flexion
b. 0 degrees extension, 90 degrees flexion
c. 5 degrees extension, 80 degrees flexion
d. 10 degrees extension and 90 degrees flexion
1. B: Hypocalcemia is a contraindication because bisphosphonates induce hypocalcemia and will worsen the condition. More than 99% of calcium (Ca) is in the skeletal system with 1% in serum, but it is important for transmitting nerve impulses and regulating contraction and relaxation of the muscles, including the myocardium. Calcium levels should be monitored periodically during bisphosphonate therapy, and any indication of hypocalcemia, such as tetany, tingling, seizures, altered mental status, and ventricular tachycardia should be treated with calcium and vitamin D supplementation.
Normal values: 8.2 to 10.2 mg/dL
Hypocalcemia: <8.2. Critical value: <7 mg/dL
Hypercalcemia: >10.2 mg/dL. Critical value: >12 mg/dL
2. C: A fractured sacrum is associated with increased risk of paralytic ileus, so the patient's bowel sounds should be monitored frequently. A stable pelvic structure (including a fractured sacrum) usually heals fairly rapidly because the blood supply is good; however, pelvic fractures increase risk of fat embolism and DVT from inactivity. Avascular necrosis may occur with any bone if the blood supply is disrupted, but it is most common in the shoulder, hip (femoral head), and knee.
3. B: If there is considerable deformity but a posterior tibial pulse/dorsal pedal is still evident, then no attempt should be made to straighten the leg; it should be splinted in the position found to prevent further injury. Both dislocations and fractures have similar symptoms-pain, edema, deformity-but the pain with dislocation is often acute and severe, while pain related to knee fracture may be more obvious on palpation. Patellar dislocations are a less severe injury than knee dislocation and may result from twisting injuries or blunt trauma, and there is less pronounced deformity than with a knee dislocation.
4. A: Adduction is contraindicated after hip replacement surgery as it may result in dislocation of the prosthesis. The patient should be advised to maintain abduction by keeping the knees separated when sitting and placing a pillow between the knees when in bed. Flexion should not exceed 90?, so the patient must avoid bending to reach for items, to dress, or to sit on a toilet (which should be elevated). Internal rotation of the hip may also result in dislocation.
5. B: The extension/flexion goal is 0 degrees extension (full) and 90 degrees flexion. The purpose of the CPM device is to promote circulation, decrease incidence of complications (such as thromboembolia), and increase ROM. The CPM device is applied after surgery and should be used as much as possible in the initial postoperative period, although the patient is encouraged to begin ambulation, with the knee immobilized and restricted weight-bearing, within a day of surgery. The leg should be elevated when the patient is sitting.
Last Updated: 07/05/2018