ONC General Practice Exam 50 Questions and
Answers.
To establish the diagnosis of osteoporosis, a patient's primary care provider orders a
DEXA scan (dual energy x-ray absorptiometry). The patient asks the nurse, "How will the
test show if I have osteoporosis?" The nurse's response should be based on knowledge
that which of the following accurately describes this procedure?
a. The patient will be given a radioactive isotope several hours before the scan, and its
uptake into the patient's bones will be measured.
b. The patient's bone density will be compared to the reference range of healthy young
adults.
c. The amount of calcium in the patient's bones will be compared to the patient's serum
values of osteocalcin and alkaline phosphatase.
d. The patient's peak bone mass will be measured by comparing the ratio of cortical to
cancellous bone in her distal forearm. - Correct Answer b. The patient's bone density will
be compared to the reference range of healthy young adults.
Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean
young adult normal reference range (known as the T-score). DEXA is a noninvasive
diagnostic that does not require the use of a radioisotope. There are also no associated
laboratory studies, and assessment of the distal forearm is not completed as part of DEXA
scanning.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96
A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is
prescribed. The nurse should give which of these instructions about the drug to the
patient?
a. "Take the Actonel at night immediately before you got to bed."
b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption
of the Actonel."
c. "After taking Actonel, remain in an upright position for at least 30 minutes."
d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." -
Correct Answer c. "After taking Actonel, remain in an upright position for at least 30
minutes."
,Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at
least 30 minutes before breakfast, and the patient should remain in an upright position.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1
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 - Correct Answer 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. - Correct Answer b. She smokes one pack of cigarettes per
day.
, 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 - Correct Answer 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 - Correct Answer 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).
Answers.
To establish the diagnosis of osteoporosis, a patient's primary care provider orders a
DEXA scan (dual energy x-ray absorptiometry). The patient asks the nurse, "How will the
test show if I have osteoporosis?" The nurse's response should be based on knowledge
that which of the following accurately describes this procedure?
a. The patient will be given a radioactive isotope several hours before the scan, and its
uptake into the patient's bones will be measured.
b. The patient's bone density will be compared to the reference range of healthy young
adults.
c. The amount of calcium in the patient's bones will be compared to the patient's serum
values of osteocalcin and alkaline phosphatase.
d. The patient's peak bone mass will be measured by comparing the ratio of cortical to
cancellous bone in her distal forearm. - Correct Answer b. The patient's bone density will
be compared to the reference range of healthy young adults.
Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean
young adult normal reference range (known as the T-score). DEXA is a noninvasive
diagnostic that does not require the use of a radioisotope. There are also no associated
laboratory studies, and assessment of the distal forearm is not completed as part of DEXA
scanning.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96
A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is
prescribed. The nurse should give which of these instructions about the drug to the
patient?
a. "Take the Actonel at night immediately before you got to bed."
b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption
of the Actonel."
c. "After taking Actonel, remain in an upright position for at least 30 minutes."
d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." -
Correct Answer c. "After taking Actonel, remain in an upright position for at least 30
minutes."
,Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at
least 30 minutes before breakfast, and the patient should remain in an upright position.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1
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 - Correct Answer 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. - Correct Answer b. She smokes one pack of cigarettes per
day.
, 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 - Correct Answer 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 - Correct Answer 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).
