ORTHOPEDIC NURSE CERTIFICATION (ONC)
COMPLETE QUESTION EXAM BANK & EXPERT
RATIONALES (LATEST EDITION)
This premium ONC practice exam bank features high-yield multiple-
choice questions complete with verified answers and comprehensive,
evidence-based rationales. It provides exhaustive coverage of core
orthopedic nursing competencies, including complex fracture
management, joint replacement protocols, pediatric deformities, and
advanced musculoskeletal pharmacology. Tailored specifically for
active-recall study, this document is the ultimate high-conversion
resource designed to help nursing students and clinical professionals
ace their certification exams.
Questions 1–10: Musculoskeletal Trauma &
Compartment Syndrome
1. A patient with a closed femur fracture reports
sudden, severe calf pain. Physical assessment reveals a
tense, swollen calf, pain on passive dorsiflexion, and
delayed capillary refill. What is the priority nursing
action?
A. Elevate the leg above heart level to reduce swelling.
B. Apply a warm compress to promote local blood
circulation.
C. Notify the orthopedic surgeon immediately.
D. Administer the ordered continuous passive motion
,(CPM) therapy.
Answer: C. Notify the orthopedic surgeon immediately.
Rationale: These findings are classic indicators of acute
compartment syndrome, a surgical emergency requiring
immediate fasciotomy. Elevating the limb above the
heart worsens ischemia by lowering arterial perfusion
pressure. Heat application increases metabolic demand
in tissue that is already oxygen-deprived.
2. Which of the following is considered the earliest,
most reliable subjective sign of acute compartment
syndrome in a post-operative orthopedic patient?
A. Loss of distal pulses
B. Deep, throbbing pain out of proportion to the injury
C. Paresthesia along the nerve pathway
D. Cool, pale, and cyanotic skin
Answer: B. Deep, throbbing pain out of proportion to the
injury
Rationale: Severe pain that is disproportionate to the
injury and unrelieved by opioid analgesics is the earliest
and most reliable sign. Pulselessness, paralysis, and
pallor are late, ominous signs indicating irreversible
nerve and muscle damage.
3. A nurse cares for a patient in a newly applied
fiberglass extremity cast. Which instruction must be
,included in the patient’s immediate discharge teaching?
A. Keep the cast covered with plastic for the first 24
hours to cure it.
B. Use a hair dryer on a hot setting if the skin underneath
scratches or itches.
C. Report any "hot spots" or foul odors coming from
inside the cast immediately.
D. Insert a long cotton swab gently to adjust the padding
if it wrinkles.
Answer: C. Report any "hot spots" or foul odors coming
from inside the cast immediately.
Rationale: Hot spots and foul odors indicate localized
tissue pressure necrosis or infection beneath the cast.
Fiberglass cures within minutes, not 24 hours. Heat from
a hair dryer can cause thermal burns under a cast, and
inserting any foreign object can tear skin and introduce
infection.
4. A 24-year-old male sustains a severe pelvic fracture in
a motor vehicle accident. The nurse monitors for which
major, life-threatening systemic complication within the
first 24 hours?
A. Avascular necrosis of the femoral head
B. Hypovolemic shock
C. Osteomyelitis
D. Extravasation of urine
, Answer: B. Hypovolemic shock
Rationale: The pelvis is highly vascular, and fractures
can lead to massive concealed retroperitoneal
hemorrhage, resulting in rapid hypovolemic shock.
While avascular necrosis, infection, and urological
injuries can occur, hypovolemia represents the most
immediate threat to survival.
5. A patient with a displaced tibia fracture is placed in
skin traction (Buck’s traction) pending surgery. What is
the primary therapeutic purpose of this traction?
A. To achieve permanent anatomical reduction of the
bone fragments
B. To immobilize the joint and reduce muscle spasms and
pain
C. To permit early, active weight-bearing exercises
D. To correct long-standing skeletal deformities
Answer: B. To immobilize the joint and reduce muscle
spasms and pain
Rationale: Buck's traction is a temporary skin traction
applied to immobilize the limb, minimize painful muscle
spasms, and maintain alignment before definitive
surgical fixation. It does not achieve permanent
reduction or allow weight-bearing.
COMPLETE QUESTION EXAM BANK & EXPERT
RATIONALES (LATEST EDITION)
This premium ONC practice exam bank features high-yield multiple-
choice questions complete with verified answers and comprehensive,
evidence-based rationales. It provides exhaustive coverage of core
orthopedic nursing competencies, including complex fracture
management, joint replacement protocols, pediatric deformities, and
advanced musculoskeletal pharmacology. Tailored specifically for
active-recall study, this document is the ultimate high-conversion
resource designed to help nursing students and clinical professionals
ace their certification exams.
Questions 1–10: Musculoskeletal Trauma &
Compartment Syndrome
1. A patient with a closed femur fracture reports
sudden, severe calf pain. Physical assessment reveals a
tense, swollen calf, pain on passive dorsiflexion, and
delayed capillary refill. What is the priority nursing
action?
A. Elevate the leg above heart level to reduce swelling.
B. Apply a warm compress to promote local blood
circulation.
C. Notify the orthopedic surgeon immediately.
D. Administer the ordered continuous passive motion
,(CPM) therapy.
Answer: C. Notify the orthopedic surgeon immediately.
Rationale: These findings are classic indicators of acute
compartment syndrome, a surgical emergency requiring
immediate fasciotomy. Elevating the limb above the
heart worsens ischemia by lowering arterial perfusion
pressure. Heat application increases metabolic demand
in tissue that is already oxygen-deprived.
2. Which of the following is considered the earliest,
most reliable subjective sign of acute compartment
syndrome in a post-operative orthopedic patient?
A. Loss of distal pulses
B. Deep, throbbing pain out of proportion to the injury
C. Paresthesia along the nerve pathway
D. Cool, pale, and cyanotic skin
Answer: B. Deep, throbbing pain out of proportion to the
injury
Rationale: Severe pain that is disproportionate to the
injury and unrelieved by opioid analgesics is the earliest
and most reliable sign. Pulselessness, paralysis, and
pallor are late, ominous signs indicating irreversible
nerve and muscle damage.
3. A nurse cares for a patient in a newly applied
fiberglass extremity cast. Which instruction must be
,included in the patient’s immediate discharge teaching?
A. Keep the cast covered with plastic for the first 24
hours to cure it.
B. Use a hair dryer on a hot setting if the skin underneath
scratches or itches.
C. Report any "hot spots" or foul odors coming from
inside the cast immediately.
D. Insert a long cotton swab gently to adjust the padding
if it wrinkles.
Answer: C. Report any "hot spots" or foul odors coming
from inside the cast immediately.
Rationale: Hot spots and foul odors indicate localized
tissue pressure necrosis or infection beneath the cast.
Fiberglass cures within minutes, not 24 hours. Heat from
a hair dryer can cause thermal burns under a cast, and
inserting any foreign object can tear skin and introduce
infection.
4. A 24-year-old male sustains a severe pelvic fracture in
a motor vehicle accident. The nurse monitors for which
major, life-threatening systemic complication within the
first 24 hours?
A. Avascular necrosis of the femoral head
B. Hypovolemic shock
C. Osteomyelitis
D. Extravasation of urine
, Answer: B. Hypovolemic shock
Rationale: The pelvis is highly vascular, and fractures
can lead to massive concealed retroperitoneal
hemorrhage, resulting in rapid hypovolemic shock.
While avascular necrosis, infection, and urological
injuries can occur, hypovolemia represents the most
immediate threat to survival.
5. A patient with a displaced tibia fracture is placed in
skin traction (Buck’s traction) pending surgery. What is
the primary therapeutic purpose of this traction?
A. To achieve permanent anatomical reduction of the
bone fragments
B. To immobilize the joint and reduce muscle spasms and
pain
C. To permit early, active weight-bearing exercises
D. To correct long-standing skeletal deformities
Answer: B. To immobilize the joint and reduce muscle
spasms and pain
Rationale: Buck's traction is a temporary skin traction
applied to immobilize the limb, minimize painful muscle
spasms, and maintain alignment before definitive
surgical fixation. It does not achieve permanent
reduction or allow weight-bearing.
