ONC GENERAL PRACTICE EXAM
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
To establish the diagnosis of osteoporosis, a patient's primary care provider orders a DEXA scan (dual energ
S S S S S S S S S S S S S S S S
y x-S
ray absorptiometry). The patient asks the nurse, "How will the test show if I have osteoporosis?" The nurse'
S S S S S S S S S S S S S S S S S
s response should be based on knowledge that which of the following accurately describes this procedure?
S S S S S S S S S S S S S S S
a. The patient will be given a radioactive isotope several hours before the scan, and its uptake into the patie
S S S S S S S S S S S S S S S S S S S
nt's bones will be measured.
S S S S
b. The patient's bone density will be compared to the reference range of healthy young adults.
S S S S S S S S S S S S S S S
c. The amount of calcium in the patient's bones will be compared to the patient's serum values of osteocalc
S S S S S S S S S S S S S S S S S S
in and alkaline phosphatase.
S S S
d. The patient's peak bone mass will be measured by comparing the ratio of cortical to cancellous bone in h
S S S S S S S S S S S S S S S S S S S
er distal forearm. -
S S S
ANSWER b. The patient's bone density will be compared to the reference range of healthy young adults.
S S S S S S S S S S S S S S S S S
Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean young adult norm
S S S S S S S S S S S S S S S S S S S
al reference range (known as the T-
S S S S S S
score). DEXA is a noninvasive diagnostic that does not require the use of a radioisotope. There are also no a
S S S S S S S S S S S S S S S S S S S
ssociated laboratory studies, and assessment of the distal forearm is not completed as part of DEXA scanni
S S S S S S S S S S S S S S S S
ng.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96
S S S S S S S S S S
A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is prescribed. The nurse
S S S S S S S S S S S S S S
should give which of these instructions about the drug to the patient?
S S S S S S S S S S S S
a. "Take the Actonel at night immediately before you got to bed."
S S S S S S S S S S S
b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption of the Actonel."
S S S S S S S S S S S S S S S S S S
c. "After taking Actonel, remain in an upright position for at least 30 minutes."
S S S S S S S S S S S S S
d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." -
S S S S S S S S S S S S S S
ANSWER c. "After taking Actonel, remain in an upright position for at least 30 minutes."
S S S S S S S S S S S S S S S
,Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at least 30 minutes bef
S S S S S S S S S S S S S S S S S
ore breakfast, and the patient should remain in an upright position.
S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1
S S S S S S S S S S S S
A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient understand
S S S S S S S S S S S S S S
s this disease is caused by inadequate intake of vitamin D, but asks the nurse what other factors may have c
S S S S S S S S S S S S S S S S S S S S
ontributed to development of this condition. Based on the patient's history, the nurse should identify whic
S S S S S S S S S S S S S S S
h of the following as a risk factor for decreased synthesis of vitamin D?
S S S S S S S S S S S S S
a. Having renal disease
S S S
b. Having light skin
S S S
c. Living at low altitude
S S S S
d. Living on a farm - ANSWER a. Having renal disease
S S S S S S S S S S
Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased bone
S S S S S S S S S S S S S S S S
mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as fair skin.
S S S S S S S S S S S S S S S S S S
Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at lower altitud
S S S S S S S S S S S S S S S S S S S
es. Living on a farm has no direct impact, but living in long-
S S S S S S S S S S S S
term care facilities with limited exposure to sunlight can affect vitamin D synthesis.
S S S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
S S S S S S S S S S
The mother of a 50-year-
S S S S
old patient has been diagnosed with osteoporosis. The patient asks about her own risk for the disease. Bas
S S S S S S S S S S S S S S S S S
ed on discussion with the patient about her history and lifestyle, the nurse should identify which of the foll
S S S S S S S S S S S S S S S S S S
owing as a risk factor for osteoporosis?
S S S S S S
a. She is 10 pounds overweight.
S S S S S
b. She smokes one pack of cigarettes per day.
S S S S S S S S
c. She drinks two cups of coffee every morning.
S S S S S S S S
d. She never had children. - ANSWER b. She smokes one pack of cigarettes per day.
S S S S S S S S S S S S S S S
Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset of m
S S S S S S S S S S S S S S S S
enopause and the lowering of bone mineral density. Being overweight does not contribute to osteoporosis
S S S S S S S S S S S S S S
, ; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor. Never having had c
S S S S S S S S S S S S S S S S S S S S S
hildren is only a factor if it contributes to early menopause.
S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
S S S S S S S S S S
A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands, feet, a
S S S S S S S S S S S S S S S S S S S
nd knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and encourages ev
S S S S S S S S S S S S S S S S S
aluation by a healthcare provider. What other, early symptom should lead the nurse to suspect RA?
S S S S S S S S S S S S S S S
a. Hip pain
S S
b. Photosensitivity
S
c. Weight gain
S S
d. Fatigue - ANSWER d. Fatigue
S S S S S
Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.
S S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
S S S S S S S S S S
After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness, a p
S S S S S S S S S S S S S S S S
atient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are likely to in
S S S S S S S S S S S S S S S S S
clude which of the following?
S S S S
a. Erythrocyte sedimentation rate 20 mm/hr
S S S S S
b. Rheumatoid factor 12 IU/ml
S S S S
c. Serum uric acid 7.6 mg/dL
S S S S S
d. White blood cell count 7000 cells/microliter - ANSWER c. Serum uric acid 7.6 mg/dL
S S S S S S S S S S S S S S
Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis becaus
S S S S S S S S S S S S S S S S
e of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute inflammation, a value
S S S S S S S S S S S S S S S S S S
of 20 mm/hr is normal (0-22 for men, 0-
S S S S S S S S
29 for women). Less than 14 IU/ml is considered a normal RF value, as is 7000 white cells/microliter (norma
S S S S S S S S S S S S S S S S S S
l 4000-11,000).
S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
S S S S S S S S S S
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
To establish the diagnosis of osteoporosis, a patient's primary care provider orders a DEXA scan (dual energ
S S S S S S S S S S S S S S S S
y x-S
ray absorptiometry). The patient asks the nurse, "How will the test show if I have osteoporosis?" The nurse'
S S S S S S S S S S S S S S S S S
s response should be based on knowledge that which of the following accurately describes this procedure?
S S S S S S S S S S S S S S S
a. The patient will be given a radioactive isotope several hours before the scan, and its uptake into the patie
S S S S S S S S S S S S S S S S S S S
nt's bones will be measured.
S S S S
b. The patient's bone density will be compared to the reference range of healthy young adults.
S S S S S S S S S S S S S S S
c. The amount of calcium in the patient's bones will be compared to the patient's serum values of osteocalc
S S S S S S S S S S S S S S S S S S
in and alkaline phosphatase.
S S S
d. The patient's peak bone mass will be measured by comparing the ratio of cortical to cancellous bone in h
S S S S S S S S S S S S S S S S S S S
er distal forearm. -
S S S
ANSWER b. The patient's bone density will be compared to the reference range of healthy young adults.
S S S S S S S S S S S S S S S S S
Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean young adult norm
S S S S S S S S S S S S S S S S S S S
al reference range (known as the T-
S S S S S S
score). DEXA is a noninvasive diagnostic that does not require the use of a radioisotope. There are also no a
S S S S S S S S S S S S S S S S S S S
ssociated laboratory studies, and assessment of the distal forearm is not completed as part of DEXA scanni
S S S S S S S S S S S S S S S S
ng.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96
S S S S S S S S S S
A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is prescribed. The nurse
S S S S S S S S S S S S S S
should give which of these instructions about the drug to the patient?
S S S S S S S S S S S S
a. "Take the Actonel at night immediately before you got to bed."
S S S S S S S S S S S
b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption of the Actonel."
S S S S S S S S S S S S S S S S S S
c. "After taking Actonel, remain in an upright position for at least 30 minutes."
S S S S S S S S S S S S S
d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." -
S S S S S S S S S S S S S S
ANSWER c. "After taking Actonel, remain in an upright position for at least 30 minutes."
S S S S S S S S S S S S S S S
,Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at least 30 minutes bef
S S S S S S S S S S S S S S S S S
ore breakfast, and the patient should remain in an upright position.
S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1
S S S S S S S S S S S S
A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient understand
S S S S S S S S S S S S S S
s this disease is caused by inadequate intake of vitamin D, but asks the nurse what other factors may have c
S S S S S S S S S S S S S S S S S S S S
ontributed to development of this condition. Based on the patient's history, the nurse should identify whic
S S S S S S S S S S S S S S S
h of the following as a risk factor for decreased synthesis of vitamin D?
S S S S S S S S S S S S S
a. Having renal disease
S S S
b. Having light skin
S S S
c. Living at low altitude
S S S S
d. Living on a farm - ANSWER a. Having renal disease
S S S S S S S S S S
Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased bone
S S S S S S S S S S S S S S S S
mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as fair skin.
S S S S S S S S S S S S S S S S S S
Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at lower altitud
S S S S S S S S S S S S S S S S S S S
es. Living on a farm has no direct impact, but living in long-
S S S S S S S S S S S S
term care facilities with limited exposure to sunlight can affect vitamin D synthesis.
S S S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
S S S S S S S S S S
The mother of a 50-year-
S S S S
old patient has been diagnosed with osteoporosis. The patient asks about her own risk for the disease. Bas
S S S S S S S S S S S S S S S S S
ed on discussion with the patient about her history and lifestyle, the nurse should identify which of the foll
S S S S S S S S S S S S S S S S S S
owing as a risk factor for osteoporosis?
S S S S S S
a. She is 10 pounds overweight.
S S S S S
b. She smokes one pack of cigarettes per day.
S S S S S S S S
c. She drinks two cups of coffee every morning.
S S S S S S S S
d. She never had children. - ANSWER b. She smokes one pack of cigarettes per day.
S S S S S S S S S S S S S S S
Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset of m
S S S S S S S S S S S S S S S S
enopause and the lowering of bone mineral density. Being overweight does not contribute to osteoporosis
S S S S S S S S S S S S S S
, ; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor. Never having had c
S S S S S S S S S S S S S S S S S S S S S
hildren is only a factor if it contributes to early menopause.
S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
S S S S S S S S S S
A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands, feet, a
S S S S S S S S S S S S S S S S S S S
nd knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and encourages ev
S S S S S S S S S S S S S S S S S
aluation by a healthcare provider. What other, early symptom should lead the nurse to suspect RA?
S S S S S S S S S S S S S S S
a. Hip pain
S S
b. Photosensitivity
S
c. Weight gain
S S
d. Fatigue - ANSWER d. Fatigue
S S S S S
Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.
S S S S S S S S S S S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
S S S S S S S S S S
After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness, a p
S S S S S S S S S S S S S S S S
atient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are likely to in
S S S S S S S S S S S S S S S S S
clude which of the following?
S S S S
a. Erythrocyte sedimentation rate 20 mm/hr
S S S S S
b. Rheumatoid factor 12 IU/ml
S S S S
c. Serum uric acid 7.6 mg/dL
S S S S S
d. White blood cell count 7000 cells/microliter - ANSWER c. Serum uric acid 7.6 mg/dL
S S S S S S S S S S S S S S
Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis becaus
S S S S S S S S S S S S S S S S
e of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute inflammation, a value
S S S S S S S S S S S S S S S S S S
of 20 mm/hr is normal (0-22 for men, 0-
S S S S S S S S
29 for women). Less than 14 IU/ml is considered a normal RF value, as is 7000 white cells/microliter (norma
S S S S S S S S S S S S S S S S S S
l 4000-11,000).
S
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
S S S S S S S S S S
