ORTHOPEDIC NURSE CERTIFICATION EXAM (ONC) QUESTIONS AND CORRECT SOLUTIONS JUST RELEASED
THIS YEAR………...
Core Domains:
- Musculoskeletal Anatomy and Physiology
- Assessment and Diagnostic Evaluation
- Orthopedic Injuries and Trauma Management
- Degenerative and Inflammatory Joint Disorders
- Surgical Interventions and Perioperative Care
- Pain Management and Pharmacotherapeutics
- Rehabilitation, Mobility, and Functional Outcomes
- Complications of Immobility and Musculoskeletal Conditions
- Patient and Family Education
- Ethical, Legal, and Professional Standards in Orthopedic Nursing
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical expertise required for
the Orthopedic Nurse Certification (ONC) credential. It evaluates the candidate's understanding of musculoskeletal
anatomy, pathophysiology, diagnostic procedures, and evidence-based nursing interventions across the continuum
of care. The exam emphasizes real-world clinical scenarios to test the ability to manage orthopedic trauma,
degenerative diseases, surgical outcomes, and rehabilitation processes. Through a rigorous multiple-choice format,
candidates will demonstrate their capacity to provide holistic, patient-centered care to individuals with
musculoskeletal conditions while integrating safety, ethical principles, and professional standards.
,SECTION ONE: QUESTIONS 1 – 100
1. A patient with a new hip replacement is at highest risk for which complication within the first 48 hours
postoperatively?
A. Wound infection
B. Venous thromboembolism
C. Prosthetic dislocation
D. Urinary retention
🟢 B. Venous thromboembolism
🔴 RATIONALE: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary
embolism (PE), is the most significant early postoperative complication following total hip arthroplasty. The risk
is highest within the first 48-72 hours due to venous stasis, endothelial injury, and hypercoagulability. Preventive
measures include anticoagulation and early mobilization.
2. A patient with a fractured femur is placed in skeletal traction. Which assessment finding is most indicative
of a complication related to the traction?
A. Pain rated 4 out of 10
B. Capillary refill less than 2 seconds
C. Numbness and tingling in the toes
D. Mild swelling at the pin site
🟢 C. Numbness and tingling in the toes
🔴 RATIONALE: Numbness and tingling in the toes may indicate neurovascular compromise, including peroneal
nerve palsy or compartment syndrome, which are serious complications of skeletal traction. Pin site swelling
and mild pain are expected, but neurovascular changes require immediate intervention.
3. Which laboratory finding is most consistent with a diagnosis of gout?
A. Elevated serum calcium
,B. Elevated serum uric acid
C. Elevated rheumatoid factor
D. Elevated C-reactive protein
🟢 B. Elevated serum uric acid
🔴 RATIONALE: Gout is characterized by hyperuricemia, with serum uric acid levels typically above 6.8 mg/dL.
The diagnosis is confirmed by the presence of urate crystals in joint fluid. Rheumatoid factor is associated with
rheumatoid arthritis, and elevated calcium may indicate hyperparathyroidism.
4. A patient with osteoporosis is prescribed alendronate. Which instruction is most important for the nurse
to include in patient teaching?
A. "Take this medication with a full glass of water and remain upright for 30 minutes."
B. "Take this medication with food to prevent gastrointestinal upset."
C. "This medication should be taken at bedtime with a light snack."
D. "You may take this medication with calcium supplements for better absorption."
🟢 A. "Take this medication with a full glass of water and remain upright for 30 minutes."
🔴 RATIONALE: Alendronate, a bisphosphonate, can cause esophageal irritation and ulceration. It must be
taken with a full glass of water on an empty stomach, and the patient must remain upright for at least 30
minutes to prevent reflux and esophageal damage.
5. A patient with an above-the-knee amputation is experiencing phantom limb pain. Which nursing
intervention is most appropriate?
A. Apply a warm compress to the residual limb
B. Administer opioid analgesics as prescribed
C. Encourage the patient to ignore the sensation
D. Perform range-of-motion exercises on the residual limb
🟢 B. Administer opioid analgesics as prescribed
, 🔴 RATIONALE: Phantom limb pain is a neuropathic pain phenomenon that can be severe. Management
includes pharmacological interventions such as opioids, antidepressants, anticonvulsants, and non-
pharmacological therapies like mirror therapy. Warm compresses and ignoring the pain are not appropriate
interventions.
6. A patient with a total knee replacement is prescribed continuous passive motion (CPM). The primary
purpose of this therapy is to:
A. Strengthen the quadriceps muscle
B. Increase the range of motion and prevent adhesions
C. Improve wound healing
D. Prevent deep vein thrombosis
🟢 B. Increase the range of motion and prevent adhesions
🔴 RATIONALE: Continuous passive motion (CPM) is used after total knee replacement to promote knee flexion
and extension, reduce stiffness, and prevent the formation of intra-articular adhesions. It does not strengthen
muscles, which requires active exercise.
7. A patient with a fractured tibia is placed in a long leg cast. The nurse should assess for which early sign of
compartment syndrome?
A. Pulselessness in the foot
B. Severe, unrelenting pain not relieved by elevation
C. Paralysis of the toes
D. Pallor of the foot
🟢 B. Severe, unrelenting pain not relieved by elevation
🔴 RATIONALE: The earliest and most reliable sign of compartment syndrome is severe, unrelenting pain that is
disproportionate to the injury and not relieved by elevation or analgesia. Pulselessness, paralysis, and pallor are
late signs that indicate irreversible damage.
THIS YEAR………...
Core Domains:
- Musculoskeletal Anatomy and Physiology
- Assessment and Diagnostic Evaluation
- Orthopedic Injuries and Trauma Management
- Degenerative and Inflammatory Joint Disorders
- Surgical Interventions and Perioperative Care
- Pain Management and Pharmacotherapeutics
- Rehabilitation, Mobility, and Functional Outcomes
- Complications of Immobility and Musculoskeletal Conditions
- Patient and Family Education
- Ethical, Legal, and Professional Standards in Orthopedic Nursing
Introduction
This comprehensive examination is designed to assess the advanced knowledge and clinical expertise required for
the Orthopedic Nurse Certification (ONC) credential. It evaluates the candidate's understanding of musculoskeletal
anatomy, pathophysiology, diagnostic procedures, and evidence-based nursing interventions across the continuum
of care. The exam emphasizes real-world clinical scenarios to test the ability to manage orthopedic trauma,
degenerative diseases, surgical outcomes, and rehabilitation processes. Through a rigorous multiple-choice format,
candidates will demonstrate their capacity to provide holistic, patient-centered care to individuals with
musculoskeletal conditions while integrating safety, ethical principles, and professional standards.
,SECTION ONE: QUESTIONS 1 – 100
1. A patient with a new hip replacement is at highest risk for which complication within the first 48 hours
postoperatively?
A. Wound infection
B. Venous thromboembolism
C. Prosthetic dislocation
D. Urinary retention
🟢 B. Venous thromboembolism
🔴 RATIONALE: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary
embolism (PE), is the most significant early postoperative complication following total hip arthroplasty. The risk
is highest within the first 48-72 hours due to venous stasis, endothelial injury, and hypercoagulability. Preventive
measures include anticoagulation and early mobilization.
2. A patient with a fractured femur is placed in skeletal traction. Which assessment finding is most indicative
of a complication related to the traction?
A. Pain rated 4 out of 10
B. Capillary refill less than 2 seconds
C. Numbness and tingling in the toes
D. Mild swelling at the pin site
🟢 C. Numbness and tingling in the toes
🔴 RATIONALE: Numbness and tingling in the toes may indicate neurovascular compromise, including peroneal
nerve palsy or compartment syndrome, which are serious complications of skeletal traction. Pin site swelling
and mild pain are expected, but neurovascular changes require immediate intervention.
3. Which laboratory finding is most consistent with a diagnosis of gout?
A. Elevated serum calcium
,B. Elevated serum uric acid
C. Elevated rheumatoid factor
D. Elevated C-reactive protein
🟢 B. Elevated serum uric acid
🔴 RATIONALE: Gout is characterized by hyperuricemia, with serum uric acid levels typically above 6.8 mg/dL.
The diagnosis is confirmed by the presence of urate crystals in joint fluid. Rheumatoid factor is associated with
rheumatoid arthritis, and elevated calcium may indicate hyperparathyroidism.
4. A patient with osteoporosis is prescribed alendronate. Which instruction is most important for the nurse
to include in patient teaching?
A. "Take this medication with a full glass of water and remain upright for 30 minutes."
B. "Take this medication with food to prevent gastrointestinal upset."
C. "This medication should be taken at bedtime with a light snack."
D. "You may take this medication with calcium supplements for better absorption."
🟢 A. "Take this medication with a full glass of water and remain upright for 30 minutes."
🔴 RATIONALE: Alendronate, a bisphosphonate, can cause esophageal irritation and ulceration. It must be
taken with a full glass of water on an empty stomach, and the patient must remain upright for at least 30
minutes to prevent reflux and esophageal damage.
5. A patient with an above-the-knee amputation is experiencing phantom limb pain. Which nursing
intervention is most appropriate?
A. Apply a warm compress to the residual limb
B. Administer opioid analgesics as prescribed
C. Encourage the patient to ignore the sensation
D. Perform range-of-motion exercises on the residual limb
🟢 B. Administer opioid analgesics as prescribed
, 🔴 RATIONALE: Phantom limb pain is a neuropathic pain phenomenon that can be severe. Management
includes pharmacological interventions such as opioids, antidepressants, anticonvulsants, and non-
pharmacological therapies like mirror therapy. Warm compresses and ignoring the pain are not appropriate
interventions.
6. A patient with a total knee replacement is prescribed continuous passive motion (CPM). The primary
purpose of this therapy is to:
A. Strengthen the quadriceps muscle
B. Increase the range of motion and prevent adhesions
C. Improve wound healing
D. Prevent deep vein thrombosis
🟢 B. Increase the range of motion and prevent adhesions
🔴 RATIONALE: Continuous passive motion (CPM) is used after total knee replacement to promote knee flexion
and extension, reduce stiffness, and prevent the formation of intra-articular adhesions. It does not strengthen
muscles, which requires active exercise.
7. A patient with a fractured tibia is placed in a long leg cast. The nurse should assess for which early sign of
compartment syndrome?
A. Pulselessness in the foot
B. Severe, unrelenting pain not relieved by elevation
C. Paralysis of the toes
D. Pallor of the foot
🟢 B. Severe, unrelenting pain not relieved by elevation
🔴 RATIONALE: The earliest and most reliable sign of compartment syndrome is severe, unrelenting pain that is
disproportionate to the injury and not relieved by elevation or analgesia. Pulselessness, paralysis, and pallor are
late signs that indicate irreversible damage.
