ONC General Practice Exam Questions with
Verified Answers Latest Versions
A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient
understands this disease is caused by inadequate intake of vitamin D, but asks the nurse what other
factors may have contributed to development of this condition. Based on the patient's history, the nurse
should identify which of the following as a risk factor for decreased synthesis of vitamin D?
a. Having renal disease
b. Having light skin
c. Living at low altitude
d. Living on a farm - a. Having renal disease
Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased
bone mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as
fair skin. Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at
lower altitudes. Living on a farm has no direct impact, but living in long-term care facilities with limited
exposure to sunlight can affect vitamin D synthesis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
The mother of a 50-year-old patient has been diagnosed with osteoporosis. The patient asks about her
own risk for the disease. Based on discussion with the patient about her history and lifestyle, the nurse
should identify which of the following as a risk factor for osteoporosis?
a. She is 10 pounds overweight.
b. She smokes one pack of cigarettes per day.
c. She drinks two cups of coffee every morning.
d. She never had children. - b. She smokes one pack of cigarettes per day.
,What are post-surgical hip precautions for anterior approach? - Correct answer-no external rotation of
knees/ankles, no turning towards operative side with walking, no abduction of surgical hip and no
crossing legs (ankle on knee or knee on knee), LESS PRECAUTIONS
What are post-surgical hip precautions for posterior approach? - Correct answer-no bending at waist
greater than 90 degrees, don't sit cross-legged, no internal rotation on surgical side, must sleep with
pillow between knees and external rotation of legs
Positioning for hip surgery with anterior approach means: - Correct answer-patient lying supine, hip
extended and in external rotation, and knee flexed, can also be done with posterior approach
positioning
Positioning for hip surgery with posterior approach means: - Correct answer-patient lies on unaffected
side, with affected hip in flexion, adduction and internal rotation
Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset
of menopause and the lowering of bone mineral density. Being overweight does not contribute to
osteoporosis; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor.
Never having had children is only a factor if it contributes to early menopause.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands,
feet, and knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and
encourages evaluation by a healthcare provider. What other, early symptom should lead the nurse to
suspect RA?
a. Hip pain
b. Photosensitivity
c. Weight gain
d. Fatigue - d. Fatigue
Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.
, Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness,
a patient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are
likely to include which of the following?
a. Erythrocyte sedimentation rate 20 mm/hr
b. Rheumatoid factor 12 IU/ml
c. Serum uric acid 7.6 mg/dL
d. White blood cell count 7000 cells/microliter - c. Serum uric acid 7.6 mg/dL
Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis
because of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute
inflammation, a value of 20 mm/hr is normal (0-22 for men, 0-29 for women). Less than 14 IU/ml is
considered a normal RF value, as is 7000 white cells/microliter (normal 4000-11,000).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
A patient with newly diagnosed rheumatoid arthritis is prescribed diclofenac (Voltaren®) and
methotrexate. The nurse should understand these two medications are prescribed together primarily to
a. maximize the patient's activity level.
b. minimize steroidal side effects.
c. minimize the patient's immune response.
d. maximize control of inflammation. - d. maximize control of inflammation.
Rationale: NSAIDs are used to improve joint function by decreasing acute inflammation and pain.
However, they cannot alter the course of RA or prevent joint damage. Thus they are prescribed for use
while the patient awaits therapeutic effects of a DMARD such as methotrexate or a biologic response
modifier.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 342-344
Verified Answers Latest Versions
A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient
understands this disease is caused by inadequate intake of vitamin D, but asks the nurse what other
factors may have contributed to development of this condition. Based on the patient's history, the nurse
should identify which of the following as a risk factor for decreased synthesis of vitamin D?
a. Having renal disease
b. Having light skin
c. Living at low altitude
d. Living on a farm - a. Having renal disease
Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased
bone mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as
fair skin. Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at
lower altitudes. Living on a farm has no direct impact, but living in long-term care facilities with limited
exposure to sunlight can affect vitamin D synthesis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
The mother of a 50-year-old patient has been diagnosed with osteoporosis. The patient asks about her
own risk for the disease. Based on discussion with the patient about her history and lifestyle, the nurse
should identify which of the following as a risk factor for osteoporosis?
a. She is 10 pounds overweight.
b. She smokes one pack of cigarettes per day.
c. She drinks two cups of coffee every morning.
d. She never had children. - b. She smokes one pack of cigarettes per day.
,What are post-surgical hip precautions for anterior approach? - Correct answer-no external rotation of
knees/ankles, no turning towards operative side with walking, no abduction of surgical hip and no
crossing legs (ankle on knee or knee on knee), LESS PRECAUTIONS
What are post-surgical hip precautions for posterior approach? - Correct answer-no bending at waist
greater than 90 degrees, don't sit cross-legged, no internal rotation on surgical side, must sleep with
pillow between knees and external rotation of legs
Positioning for hip surgery with anterior approach means: - Correct answer-patient lying supine, hip
extended and in external rotation, and knee flexed, can also be done with posterior approach
positioning
Positioning for hip surgery with posterior approach means: - Correct answer-patient lies on unaffected
side, with affected hip in flexion, adduction and internal rotation
Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset
of menopause and the lowering of bone mineral density. Being overweight does not contribute to
osteoporosis; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor.
Never having had children is only a factor if it contributes to early menopause.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands,
feet, and knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and
encourages evaluation by a healthcare provider. What other, early symptom should lead the nurse to
suspect RA?
a. Hip pain
b. Photosensitivity
c. Weight gain
d. Fatigue - d. Fatigue
Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.
, Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness,
a patient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are
likely to include which of the following?
a. Erythrocyte sedimentation rate 20 mm/hr
b. Rheumatoid factor 12 IU/ml
c. Serum uric acid 7.6 mg/dL
d. White blood cell count 7000 cells/microliter - c. Serum uric acid 7.6 mg/dL
Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis
because of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute
inflammation, a value of 20 mm/hr is normal (0-22 for men, 0-29 for women). Less than 14 IU/ml is
considered a normal RF value, as is 7000 white cells/microliter (normal 4000-11,000).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
A patient with newly diagnosed rheumatoid arthritis is prescribed diclofenac (Voltaren®) and
methotrexate. The nurse should understand these two medications are prescribed together primarily to
a. maximize the patient's activity level.
b. minimize steroidal side effects.
c. minimize the patient's immune response.
d. maximize control of inflammation. - d. maximize control of inflammation.
Rationale: NSAIDs are used to improve joint function by decreasing acute inflammation and pain.
However, they cannot alter the course of RA or prevent joint damage. Thus they are prescribed for use
while the patient awaits therapeutic effects of a DMARD such as methotrexate or a biologic response
modifier.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 342-344
