Onc General Practice Exam

ONC GENERAL PRACTICE EXAM

Toooestablishootheoodiagnosisooofooosteoporosis,ooaoopatient'sooprimaryoocareooprovideroo
ordersooaooDEXAooscanoo(dualooenergyoox-
rayooabsorptiometry).ooTheoopatientooasksootheoonurse,oo"Howoowillootheootestooshowooifoo
Ioohaveooosteoporosis?"ooTheoonurse'sooresponseooshouldoobeoobasedooonooknowledgeoo
thatoowhichooofootheoofollowingooaccuratelyoodescribesoothisooprocedure?

a.ooTheoopatientoowilloobeoogivenooaooradioactiveooisotopeooseveraloohoursoobeforeootheoo
scan,ooandooitsoouptakeoointoootheoopatient'soobonesoowilloobeoomeasured.
b.ooTheoopatient'sooboneoodensityoowilloobeoocomparedootoootheooreferenceoorangeooofooh
ealthyooyoungooadults.
c.ooTheooamountooofoocalciumooinootheoopatient'soobonesoowilloobeoocomparedootoootheoop
atient'sooserumoovaluesooofooosteocalcinooandooalkalineoophosphatase.
d.ooTheoopatient'soopeakooboneoomassoowilloobeoomeasuredoobyoocomparingootheooratiooo
ofoocorticalootooocancellousooboneooinooheroodistalooforearm.oo-ooans--
b.ooTheoopatient'sooboneoodensityoowilloobeoocomparedootoootheooreferenceoorangeooofooh
ealthyooyoungooadults.

Rationale:ooDEXAoocomparesooaoopatient'sooboneoodensityooinootheoohipooandoospineootoo
othatooofooaoomeanooyoungooadultoonormalooreferenceoorangeoo(knownooasootheooT-
score).ooDEXAooisooaoononinvasiveoodiagnosticoothatoodoesoonotoorequireootheoouseooofoo
aooradioisotope.ooThereooareooalsooonoooassociatedoolaboratoryoostudies,ooandooassess
mentooofootheoodistalooforearmooisoonotoocompletedooasoopartooofooDEXAooscanning.
Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo96

Aoopatientooisoonewlyoodiagnosedoowithooosteoporosisooandoorisedronateoosodiumoo(Acto
nel®)ooisooprescribed.ooTheoonurseooshouldoogiveoowhichooofootheseooinstructionsooabout
ootheoodrugootoootheoopatient?


a.oo"TakeootheooActonelooatoonightooimmediatelyoobeforeooyouoogotootooobed."
b.oo"Takeooaoomultivitaminoothatoocontainsoo400ooIUooofoovitaminooDooeveryoodayootooopro
moteooabsorptionooofootheooActonel."
c.oo"AfterootakingooActonel,ooremainooinooanoouprightoopositionooforooatooleastoo30oominute
s."
d.oo"BeforeootakingooActonel,ooeatooaoosmallooamountooofoofoodootooopreventoostomachooir
ritation."oo-ooans--
c.oo"AfterootakingooActonel,ooremainooinooanoouprightoopositionooforooatooleastoo30oominute
s."

,Rationale:ooBisphosphonatesoosuchooasooActonelooneedootooobeootakenooonooanooemptyo
ostomachooatooleastoo30oominutesoobeforeoobreakfast,ooandootheoopatientooshouldooremai
nooinooanoouprightooposition.
Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo380,o
oTableoo14-1


Aoopatientooisoosuspectedooofoohavingooosteomalaciaooandooisooundergoingoodiagnosticoot
esting.ooTheoopatientoounderstandsoothisoodiseaseooisoocausedoobyooinadequateoointakeoo
ofoovitaminooD,oobutooasksootheoonurseoowhatoootheroofactorsoomayoohaveoocontributedoot
ooodevelopmentooofoothisoocondition.ooBasedooonootheoopatient'soohistory,ootheoonurseoos
houldooidentifyoowhichooofootheoofollowingooasooaooriskoofactorooforoodecreasedoosynthesis
ooofoovitaminooD?


a.ooHavingoorenaloodisease
b.ooHavingoolightooskin
c.ooLivingooatoolowooaltitude
d.ooLivingooonooaoofarmoo-ooans--a.ooHavingoorenaloodisease

Rationale:ooAdultsooaffectedoobyoochronicoodiseasesooofootheooliver,ookidney,ooandoosmall
oointestineoohaveoodecreasedooboneoomineralizationoorelatedootooovitaminooDoodeficiency.
ooDarkooskinoodoesoonotoosynthesizeoovitaminooDooasooeasilyooasoofairooskin.ooPersonsoow
hoooliveooatoohighooaltitudesooalsooodooonotoosynthesizeoovitaminooDooasooreadilyooasootho
seoolivingooatoolowerooaltitudes.ooLivingooonooaoofarmoohasoonooodirectooimpact,oobutoolivin
gooinoolong-
termoocareoofacilitiesoowithoolimitedooexposureootooosunlightoocanooaffectoovitaminooDoosyn
thesis.
Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo383

Theoomotherooofooaoo50-year-
oldoopatientoohasoobeenoodiagnosedoowithooosteoporosis.ooTheoopatientooasksooaboutooh
erooownooriskooforootheoodisease.ooBasedooonoodiscussionoowithootheoopatientooaboutooher
oohistoryooandoolifestyle,ootheoonurseooshouldooidentifyoowhichooofootheoofollowingooasooaoo
riskoofactorooforooosteoporosis?

a.ooSheooisoo10oopoundsoooverweight.
b.ooSheoosmokesoooneoopackooofoocigarettesooperooday.
c.ooSheoodrinksootwooocupsooofoocoffeeooeveryoomorning.
d.ooSheooneveroohadoochildren.oo-ooans--
b.ooSheoosmokesoooneoopackooofoocigarettesooperooday.

Rationale:ooSmokingoohasoobeenooshownootoooincreaseootheooincidenceooofooosteoporosi
soobyooinfluencingootheooonsetooofoomenopauseooandootheooloweringooofooboneoomineralo
odensity.ooBeingoooverweightoodoesoonotoocontributeootoooosteoporosis;ootwooocupsooofoo
coffeeooaoodayooisoomoderateoointakeooofoocaffeineooandoonotooconsideredooaooriskoofacto
r.ooNeveroohavingoohadoochildrenooisooonlyooaoofactorooifooitoocontributesootoooearlyoomeno
pause.

, Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo379

Aoocloseoofriendooofootheoonurseoohasooexperiencedoointermittentooswellingooandoopainooi
nootheoojointsooofootheoohands,oofeet,ooandookneesoooverootheoopastooyear.ooTheoonurseoo
suspectsootheoofriendoohasoorheumatoidooarthritisoo(RA)ooandooencouragesooevaluationoo
byooaoohealthcareooprovider.ooWhatooother,ooearlyoosymptomooshouldooleadootheoonurseoo
tooosuspectooRA?

a.ooHipoopain
b.ooPhotosensitivity
c.ooWeightoogain
d.ooFatigueoo-ooans--d.ooFatigue

Rationale:ooFatigue,oolethargy,ooandooweightoolossooareoocommonooearlyoosymptomsooofo
oRA.
Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo341

Afterooanooacuteooepisodeooofoopainfulooswellingooofoomultipleoojointsooaccompaniedoobyo
odisablingoomorningoostiffness,ooaoopatientooisoodiagnosedoowithoopsoriaticooarthritis.ooThe
oonurseooshouldoorecognizeoothatoobloodootestooresultsooareoolikelyootoooincludeoowhichooo
footheoofollowing?

a.ooErythrocyteoosedimentationoorateoo20oomm/hr
b.ooRheumatoidoofactoroo12ooIU/ml
c.ooSerumoouricooacidoo7.6oomg/dL
d.ooWhiteoobloodoocelloocountoo7000oocells/microliteroo-ooans--
c.ooSerumoouricooacidoo7.6oomg/dL

Rationale:ooHyperuricemiaoo(greateroothanoo7oomg/dLooinoomen,oo6oomg/
dLooinoowomen)ooisoopossibleooinoopsoriasisoobecauseooofoorapidoocellooturnover.ooWhileoo
ESRoomayoobeooelevatedooinoopsoriaticooarthritisooduringooacuteooinflammation,ooaoovalue
ooofoo20oomm/hrooisoonormaloo(0-22ooforoomen,oo0-
29ooforoowomen).ooLessoothanoo14ooIU/
mlooisooconsideredooaoonormalooRFoovalue,ooasooisoo7000oowhiteoocells/
microliteroo(normaloo4000-11,000).
Reference:ooCoreooCurriculumooforooOrthopaedicooNursingoo(7thooed.),oo2013,oop.oo363

Aoopatientoowithoonewlyoodiagnosedoorheumatoidooarthritisooisooprescribedoodiclofenacoo(
Voltaren®)ooandoomethotrexate.ooTheoonurseooshouldoounderstandootheseootwooomedicat
ionsooareooprescribedootogetherooprimarilyooto

a.oomaximizeootheoopatient'sooactivityoolevel.
b.oominimizeoosteroidaloosideooeffects.
c.oominimizeootheoopatient'sooimmuneooresponse.
d.oomaximizeoocontrolooofooinflammation.oo-ooans--
d.oomaximizeoocontrolooofooinflammation.