ONC Practice Exam with Complete Rationale

A patient is diagnosed with osteoid osteoma. The nurse should be able to confirm this is a benign tumor that a. requires wide excision in 90% of affected patients. b. causes night pain that can be relieved by aspirin. c. usually develops into a large osteoblastic lesion. d. occurs most often in the spine and femur. ️️ b. causes night pain that can be relieved by aspirin. Rationale: As a primary benign tumor, osteoid osteoma is characterized by night pain often relieved by aspirin or NSAIDs. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 425 While discussing the treatment plan for an adolescent with a malignancy of the distal femur, the nurse should explain to the family that the most common malignant bone tumor in children and adolescents is a. osteoblastoma. b. chondrosarcoma. c. osteosarcoma. d. osteochondroma ️️ c. osteosarcoma. Rationale: Osteosarcoma is the most common primary malignant bone tumor in children, with occurrence greater in boys than girls. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 430 A patient is diagnosed with slipped capital femoral epiphysis (SCFE). The nurse should recognize the patient is at higher than normal risk of developing a. progressive deformity. b. severe growth failure. c. joint contracture. d. secondary osteoarthritis. ️️ d. secondary osteoarthritis. Rationale: The patient with SCFE is at risk for developing secondary osteoarthritis related to chondrolysis, AVN, or deformity from SCFE. The other conditions are not considerations with SCFE. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 314 A 12-year-old cross-country runner has been diagnosed with Osgood-Schlatter disease. While reviewing the overall treatment plan with the patient and family, the nurse should include information about which of the following? a. Symptoms will stop by the end of skeletal growth. b. Long-term damage to the knee can result if inflammation persists. c. Pain may be relieved by flexion exercises. d. Surgery will offer the best hope of symptom relief. ️️ a. Symptoms will stop by the end of skeletal growth. Rationale: Osgood-Schlatter disease is a self-limiting condition of pre-adolescence; symptoms stop when apophysis is fully ossified. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302 The nurse is providing pre-operative teaching to a patient scheduled for an open reduction-internal fixation (ORIF) of the femur. Which of the following biologic implants should the nurse recognize is used to fill in bony defects? a. Cannulated screw b. Cortical strut c. Polypropylene cup d. Compression plate ️️ b. Cortical strut Rationale: Biologic implants include bone and allograft tissue such as a cortical strut. The other options are not biologic implants. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 134; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92 While caring for a patient undergoing a shoulder arthroscopy, the nurse assists with positioning the patient in a lateral decubitus position. Which of the following nerves should the nurse recognize may sustain injury when the patient is placed in the lateral position and there is inadequate padding under the fibular head? a. Saphenous b. Tibial c. Sural d. Peroneal ️️ d. Peroneal Rationale: Peroneal nerve damage is caused by compression over the lateral aspect of the fibular head or from prolonged plantar flexion of the foot. The saphenous nerve runs superficially at the medial thigh and may be impaired by direct compression from a tourniquet or arthroscopic leg holder. The tibial nerve diverges at the popliteal fossa and travels down the leg to the medial aspect of the ankle. The sural nerve is found laterally at the ankle and foot. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 129; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 50 Two days before scheduled total hip arthroplasty, a patient comes to the surgeon's office for the final preoperative assessment. Which of the following statements by the patient should require further investigation by the nurse? a. "It's hard for me to get moving in the morning because I'm so stiff." b. "Every evening I drink a glass of wine." c. "I had a nasty tooth pulled last week." d. "The arthritis in my feet has been giving me trouble this week." ️️ c. "I had a nasty tooth pulled last week." Rationale: Acute infection may be a contraindication for THA due to increased risk of bacteria infecting the replaced hip. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 553 The patient undergoes right total hip arthroplasty with a posterolateral approach. Following a short stay in the post-anesthesia unit, the patient is transferred to the orthopaedic surgical unit. Which of these observations made by the nurse should indicate the positioning of the patient's right extremity is correct? a. Leg is in adducted position. b. Hip is flexed 90 degrees. c. Leg is in neutral position. d. Hip is internally rotated. ️️ c. Leg is in neutral position. Rationale: Following THA with a posterolateral approach, the patient should not flex the hip beyond 90 degrees, cross the operative leg past the body's midline (adduction), or internally rotate the surgical hip. The leg should be maintained in neutral position. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 556