ONC GENERAL PRACTICE EXAM
QUESTIONS WITH CORRECT ANSWERS
s
Tosestablishsthesdiagnosissofsosteoporosis,saspatient'ssprimaryscaresprovidersorderssasDE
XAsscans(dualsenergysx-
raysabsorptiometry).sThespatientsaskssthesnurse,s"HowswillsthestestsshowsifsIshavesosteopo
rosis?"sThesnurse'ssresponsesshouldsbesbasedsonsknowledgesthatswhichsofsthesfollowings
accuratelysdescribessthissprocedure?
a.sThespatientswillsbesgivensasradioactivesisotopesseveralshourssbeforesthesscan,sandsitssu
ptakesintosthespatient'ssbonesswillsbesmeasured.
b.sThespatient'ssbonesdensityswillsbescomparedstosthesreferencesrangesofshealthysyoungsa
dults.
c.sThesamountsofscalciumsinsthespatient'ssbonesswillsbescomparedstosthespatient'ssserumsv
aluessofsosteocalcinsandsalkalinesphosphatase.
d.sThespatient'sspeaksbonesmassswillsbesmeasuredsbyscomparingsthesratiosofscorticalstosca
ncelloussbonesinshersdistalsforearm.s-sans--
b.sThespatient'ssbonesdensityswillsbescomparedstosthesreferencesrangesofshealthysyoungsa
dults.
Rationale:sDEXAscomparessaspatient'ssbonesdensitysinstheshipsandsspinestosthatsofsasmea
nsyoungsadultsnormalsreferencesranges(knownsassthesT-
score).sDEXAsissasnoninvasivesdiagnosticsthatsdoessnotsrequiresthesusesofsasradioisotope.
sTheresaresalsosnosassociatedslaboratorysstudies,sandsassessmentsofsthesdistalsforearmsis
snotscompletedsasspartsofsDEXAsscanning.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s96
Aspatientsissnewlysdiagnosedswithsosteoporosissandsrisedronatessodiums(Actonel®)sisspre
scribed.sThesnursesshouldsgiveswhichsofsthesesinstructionssaboutsthesdrugstosthespatient?
a.s"TakesthesActonelsatsnightsimmediatelysbeforesyousgotstosbed."
b.s"Takesasmultivitaminsthatscontainss400sIUsofsvitaminsDseverysdaystospromotesabsorptio
nsofsthesActonel."
c.s"AfterstakingsActonel,sremainsinsansuprightspositionsforsatsleasts30sminutes."
d.s"BeforestakingsActonel,seatsassmallsamountsofsfoodstospreventsstomachsirritation."s-sans-
-c.s"AfterstakingsActonel,sremainsinsansuprightspositionsforsatsleasts30sminutes."
Rationale:sBisphosphonatesssuchsassActonelsneedstosbestakensonsansemptysstomachsatsl
easts30sminutessbeforesbreakfast,sandsthespatientsshouldsremainsinsansuprightsposition.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s380,sTables14-1
Aspatientsisssuspectedsofshavingsosteomalaciasandsissundergoingsdiagnosticstesting.sThes
patientsunderstandssthissdiseasesisscausedsbysinadequatesintakesofsvitaminsD,sbutsaskssth
esnurseswhatsothersfactorssmayshavescontributedstosdevelopmentsofsthisscondition.sBased
,sonsthespatient'sshistory,sthesnursesshouldsidentifyswhichsofsthesfollowingsassasrisksfactorsfo
rsdecreasedssynthesissofsvitaminsD?
a.sHavingsrenalsdisease
b.sHavingslightsskin
c.sLivingsatslowsaltitude
d.sLivingsonsasfarms-sans--a.sHavingsrenalsdisease
Rationale:sAdultssaffectedsbyschronicsdiseasessofsthesliver,skidney,sandssmallsintestinesha
vesdecreasedsbonesmineralizationsrelatedstosvitaminsDsdeficiency.sDarksskinsdoessnotssyn
thesizesvitaminsDsasseasilysassfairsskin.sPersonsswhoslivesatshighsaltitudessalsosdosnotssyn
thesizesvitaminsDsassreadilysassthoseslivingsatslowersaltitudes.sLivingsonsasfarmshassnosdire
ctsimpact,sbutslivingsinslong-
termscaresfacilitiesswithslimitedsexposurestossunlightscansaffectsvitaminsDssynthesis.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s383
Thesmothersofsas50-year-
oldspatientshassbeensdiagnosedswithsosteoporosis.sThespatientsaskssaboutshersownsrisksfo
rsthesdisease.sBasedsonsdiscussionswithsthespatientsaboutshershistorysandslifestyle,sthesnur
sesshouldsidentifyswhichsofsthesfollowingsassasrisksfactorsforsosteoporosis?
a.sShesiss10spoundssoverweight.
b.sShessmokessonespacksofscigarettesspersday.
c.sShesdrinksstwoscupssofscoffeeseverysmorning.
d.sShesnevershadschildren.s-sans--b.sShessmokessonespacksofscigarettesspersday.
Rationale:sSmokingshassbeensshownstosincreasesthesincidencesofsosteoporosissbysinfluen
cingsthesonsetsofsmenopausesandsthesloweringsofsbonesmineralsdensity.sBeingsoverweight
sdoessnotscontributestososteoporosis;stwoscupssofscoffeesasdaysissmoderatesintakesofscaffei
nesandsnotsconsideredsasrisksfactor.sNevershavingshadschildrensissonlysasfactorsifsitscontrib
utesstosearlysmenopause.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s379
Asclosesfriendsofsthesnurseshassexperiencedsintermittentsswellingsandspainsinsthesjointssofst
heshands,sfeet,sandskneessoversthespastsyear.sThesnursessuspectssthesfriendshassrheumat
oidsarthritiss(RA)sandsencouragessevaluationsbysashealthcaresprovider.sWhatsother,searlys
symptomsshouldsleadsthesnursestossuspectsRA?
a.sHipspain
b.sPhotosensitivity
c.sWeightsgain
d.sFatigues-sans--d.sFatigue
Rationale:sFatigue,slethargy,sandsweightslosssarescommonsearlyssymptomssofsRA.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s341
, Aftersansacutesepisodesofspainfulsswellingsofsmultiplesjointssaccompaniedsbysdisablingsmo
rningsstiffness,saspatientsissdiagnosedswithspsoriaticsarthritis.sThesnursesshouldsrecognizes
thatsbloodstestsresultssareslikelystosincludeswhichsofsthesfollowing?
a.sErythrocytessedimentationsrates20smm/hr
b.sRheumatoidsfactors12sIU/ml
c.sSerumsuricsacids7.6smg/dL
d.sWhitesbloodscellscounts7000scells/microliters-sans--c.sSerumsuricsacids7.6smg/dL
Rationale:sHyperuricemias(greatersthans7smg/dLsinsmen,s6smg/dLsinswomen)sisspossiblesi
nspsoriasissbecausesofsrapidscellsturnover.sWhilesESRsmaysbeselevatedsinspsoriaticsarthriti
ssduringsacutesinflammation,sasvaluesofs20smm/hrsissnormals(0-22sforsmen,s0-
29sforswomen).sLesssthans14sIU/mlsissconsideredsasnormalsRFsvalue,sassiss7000swhitescell
s/microliters(normals4000-11,000).
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s363
Aspatientswithsnewlysdiagnosedsrheumatoidsarthritississprescribedsdiclofenacs(Voltaren®)s
andsmethotrexate.sThesnursesshouldsunderstandsthesestwosmedicationssaresprescribedsto
gethersprimarilysto
a.smaximizesthespatient'ssactivityslevel.
b.sminimizessteroidalssideseffects.
c.sminimizesthespatient'ssimmunesresponse.
d.smaximizescontrolsofsinflammation.s-sans--d.smaximizescontrolsofsinflammation.
Rationale:sNSAIDssaresusedstosimprovesjointsfunctionsbysdecreasingsacutesinflammations
andspain.sHowever,stheyscannotsaltersthescoursesofsRAsorspreventsjointsdamage.sThussthe
ysaresprescribedsforsuseswhilesthespatientsawaitsstherapeuticseffectssofsasDMARDssuchsas
smethotrexatesorsasbiologicsresponsesmodifier.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,spp.s342-344
Aspatientsnewlysdiagnosedswithsankylosingsspondylitissreceivessasprescriptionsforsetanerc
epts(Enbrel®).sWhichsofsthesfollowingsstatementssshouldsthesnursesincludesinspatientsteac
hingsonsthissmedication?
a.s"Thissmedicationswillsbesgivensoncesasweeksforsyourscondition."
b.s"ThissmedicationscanscausesGIsupsetsandsmildsdiarrhea."
c.s"BessurestosusesbirthscontrolswhilestakingsthissEnbrel."
d.s"SchedulesanseyesexamseverysyearswhilestakingsEnbrelsbecausesofsthesrisksofscornealsd
amage."s-sans--a.s"Thissmedicationswillsbesgivensoncesasweeksforsyourscondition."
Rationale:sEnbrelsisstypicallysprescribedsforssubcutaneoussinjectionseverysweek,swithsthesi
nitialsdosesofs50smgsforsankylosingsspondylitis.sThissbiologicsresponsesmodifiersissnotslikel
ystoscausesGIsupsetsandsdiarrhea;sthesesproblemssaresmoreslikelyswithsDMARDs.sBirthsco
ntrolsissrecommendedsduringsusesofsthesDMARDsleflunamides(Arava®)sbecausesofsitsster
QUESTIONS WITH CORRECT ANSWERS
s
Tosestablishsthesdiagnosissofsosteoporosis,saspatient'ssprimaryscaresprovidersorderssasDE
XAsscans(dualsenergysx-
raysabsorptiometry).sThespatientsaskssthesnurse,s"HowswillsthestestsshowsifsIshavesosteopo
rosis?"sThesnurse'ssresponsesshouldsbesbasedsonsknowledgesthatswhichsofsthesfollowings
accuratelysdescribessthissprocedure?
a.sThespatientswillsbesgivensasradioactivesisotopesseveralshourssbeforesthesscan,sandsitssu
ptakesintosthespatient'ssbonesswillsbesmeasured.
b.sThespatient'ssbonesdensityswillsbescomparedstosthesreferencesrangesofshealthysyoungsa
dults.
c.sThesamountsofscalciumsinsthespatient'ssbonesswillsbescomparedstosthespatient'ssserumsv
aluessofsosteocalcinsandsalkalinesphosphatase.
d.sThespatient'sspeaksbonesmassswillsbesmeasuredsbyscomparingsthesratiosofscorticalstosca
ncelloussbonesinshersdistalsforearm.s-sans--
b.sThespatient'ssbonesdensityswillsbescomparedstosthesreferencesrangesofshealthysyoungsa
dults.
Rationale:sDEXAscomparessaspatient'ssbonesdensitysinstheshipsandsspinestosthatsofsasmea
nsyoungsadultsnormalsreferencesranges(knownsassthesT-
score).sDEXAsissasnoninvasivesdiagnosticsthatsdoessnotsrequiresthesusesofsasradioisotope.
sTheresaresalsosnosassociatedslaboratorysstudies,sandsassessmentsofsthesdistalsforearmsis
snotscompletedsasspartsofsDEXAsscanning.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s96
Aspatientsissnewlysdiagnosedswithsosteoporosissandsrisedronatessodiums(Actonel®)sisspre
scribed.sThesnursesshouldsgiveswhichsofsthesesinstructionssaboutsthesdrugstosthespatient?
a.s"TakesthesActonelsatsnightsimmediatelysbeforesyousgotstosbed."
b.s"Takesasmultivitaminsthatscontainss400sIUsofsvitaminsDseverysdaystospromotesabsorptio
nsofsthesActonel."
c.s"AfterstakingsActonel,sremainsinsansuprightspositionsforsatsleasts30sminutes."
d.s"BeforestakingsActonel,seatsassmallsamountsofsfoodstospreventsstomachsirritation."s-sans-
-c.s"AfterstakingsActonel,sremainsinsansuprightspositionsforsatsleasts30sminutes."
Rationale:sBisphosphonatesssuchsassActonelsneedstosbestakensonsansemptysstomachsatsl
easts30sminutessbeforesbreakfast,sandsthespatientsshouldsremainsinsansuprightsposition.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s380,sTables14-1
Aspatientsisssuspectedsofshavingsosteomalaciasandsissundergoingsdiagnosticstesting.sThes
patientsunderstandssthissdiseasesisscausedsbysinadequatesintakesofsvitaminsD,sbutsaskssth
esnurseswhatsothersfactorssmayshavescontributedstosdevelopmentsofsthisscondition.sBased
,sonsthespatient'sshistory,sthesnursesshouldsidentifyswhichsofsthesfollowingsassasrisksfactorsfo
rsdecreasedssynthesissofsvitaminsD?
a.sHavingsrenalsdisease
b.sHavingslightsskin
c.sLivingsatslowsaltitude
d.sLivingsonsasfarms-sans--a.sHavingsrenalsdisease
Rationale:sAdultssaffectedsbyschronicsdiseasessofsthesliver,skidney,sandssmallsintestinesha
vesdecreasedsbonesmineralizationsrelatedstosvitaminsDsdeficiency.sDarksskinsdoessnotssyn
thesizesvitaminsDsasseasilysassfairsskin.sPersonsswhoslivesatshighsaltitudessalsosdosnotssyn
thesizesvitaminsDsassreadilysassthoseslivingsatslowersaltitudes.sLivingsonsasfarmshassnosdire
ctsimpact,sbutslivingsinslong-
termscaresfacilitiesswithslimitedsexposurestossunlightscansaffectsvitaminsDssynthesis.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s383
Thesmothersofsas50-year-
oldspatientshassbeensdiagnosedswithsosteoporosis.sThespatientsaskssaboutshersownsrisksfo
rsthesdisease.sBasedsonsdiscussionswithsthespatientsaboutshershistorysandslifestyle,sthesnur
sesshouldsidentifyswhichsofsthesfollowingsassasrisksfactorsforsosteoporosis?
a.sShesiss10spoundssoverweight.
b.sShessmokessonespacksofscigarettesspersday.
c.sShesdrinksstwoscupssofscoffeeseverysmorning.
d.sShesnevershadschildren.s-sans--b.sShessmokessonespacksofscigarettesspersday.
Rationale:sSmokingshassbeensshownstosincreasesthesincidencesofsosteoporosissbysinfluen
cingsthesonsetsofsmenopausesandsthesloweringsofsbonesmineralsdensity.sBeingsoverweight
sdoessnotscontributestososteoporosis;stwoscupssofscoffeesasdaysissmoderatesintakesofscaffei
nesandsnotsconsideredsasrisksfactor.sNevershavingshadschildrensissonlysasfactorsifsitscontrib
utesstosearlysmenopause.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s379
Asclosesfriendsofsthesnurseshassexperiencedsintermittentsswellingsandspainsinsthesjointssofst
heshands,sfeet,sandskneessoversthespastsyear.sThesnursessuspectssthesfriendshassrheumat
oidsarthritiss(RA)sandsencouragessevaluationsbysashealthcaresprovider.sWhatsother,searlys
symptomsshouldsleadsthesnursestossuspectsRA?
a.sHipspain
b.sPhotosensitivity
c.sWeightsgain
d.sFatigues-sans--d.sFatigue
Rationale:sFatigue,slethargy,sandsweightslosssarescommonsearlyssymptomssofsRA.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s341
, Aftersansacutesepisodesofspainfulsswellingsofsmultiplesjointssaccompaniedsbysdisablingsmo
rningsstiffness,saspatientsissdiagnosedswithspsoriaticsarthritis.sThesnursesshouldsrecognizes
thatsbloodstestsresultssareslikelystosincludeswhichsofsthesfollowing?
a.sErythrocytessedimentationsrates20smm/hr
b.sRheumatoidsfactors12sIU/ml
c.sSerumsuricsacids7.6smg/dL
d.sWhitesbloodscellscounts7000scells/microliters-sans--c.sSerumsuricsacids7.6smg/dL
Rationale:sHyperuricemias(greatersthans7smg/dLsinsmen,s6smg/dLsinswomen)sisspossiblesi
nspsoriasissbecausesofsrapidscellsturnover.sWhilesESRsmaysbeselevatedsinspsoriaticsarthriti
ssduringsacutesinflammation,sasvaluesofs20smm/hrsissnormals(0-22sforsmen,s0-
29sforswomen).sLesssthans14sIU/mlsissconsideredsasnormalsRFsvalue,sassiss7000swhitescell
s/microliters(normals4000-11,000).
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,sp.s363
Aspatientswithsnewlysdiagnosedsrheumatoidsarthritississprescribedsdiclofenacs(Voltaren®)s
andsmethotrexate.sThesnursesshouldsunderstandsthesestwosmedicationssaresprescribedsto
gethersprimarilysto
a.smaximizesthespatient'ssactivityslevel.
b.sminimizessteroidalssideseffects.
c.sminimizesthespatient'ssimmunesresponse.
d.smaximizescontrolsofsinflammation.s-sans--d.smaximizescontrolsofsinflammation.
Rationale:sNSAIDssaresusedstosimprovesjointsfunctionsbysdecreasingsacutesinflammations
andspain.sHowever,stheyscannotsaltersthescoursesofsRAsorspreventsjointsdamage.sThussthe
ysaresprescribedsforsuseswhilesthespatientsawaitsstherapeuticseffectssofsasDMARDssuchsas
smethotrexatesorsasbiologicsresponsesmodifier.
Reference:sCoresCurriculumsforsOrthopaedicsNursings(7thsed.),s2013,spp.s342-344
Aspatientsnewlysdiagnosedswithsankylosingsspondylitissreceivessasprescriptionsforsetanerc
epts(Enbrel®).sWhichsofsthesfollowingsstatementssshouldsthesnursesincludesinspatientsteac
hingsonsthissmedication?
a.s"Thissmedicationswillsbesgivensoncesasweeksforsyourscondition."
b.s"ThissmedicationscanscausesGIsupsetsandsmildsdiarrhea."
c.s"BessurestosusesbirthscontrolswhilestakingsthissEnbrel."
d.s"SchedulesanseyesexamseverysyearswhilestakingsEnbrelsbecausesofsthesrisksofscornealsd
amage."s-sans--a.s"Thissmedicationswillsbesgivensoncesasweeksforsyourscondition."
Rationale:sEnbrelsisstypicallysprescribedsforssubcutaneoussinjectionseverysweek,swithsthesi
nitialsdosesofs50smgsforsankylosingsspondylitis.sThissbiologicsresponsesmodifiersissnotslikel
ystoscausesGIsupsetsandsdiarrhea;sthesesproblemssaresmoreslikelyswithsDMARDs.sBirthsco
ntrolsissrecommendedsduringsusesofsthesDMARDsleflunamides(Arava®)sbecausesofsitsster
