ONC General Practice Exam
QUESTIONS & ANSWERS 100%
CORRECT!!
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. - ANSWERb. 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." -
ANSWERc. "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 - ANSWERa. 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. - ANSWERb. 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 - ANSWERd. 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 - ANSWERc. 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. - ANSWERd. 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
A patient newly diagnosed with ankylosing spondylitis receives a prescription for
etanercept (Enbrel®). Which of the following statements should the nurse include in
patient teaching on this medication?
a. "This medication will be given once a week for your condition."
b. "This medication can cause GI upset and mild diarrhea."
c. "Be sure to use birth control while taking this Enbrel."
d. "Schedule an eye exam every year while taking Enbrel because of the risk of
corneal damage." - ANSWERa. "This medication will be given once a week for your
condition."
Rationale: Enbrel is typically prescribed for subcutaneous injection every week, with
the initial dose of 50 mg for ankylosing spondylitis. This biologic response modifier is
not likely to cause GI upset and diarrhea; these problems are more likely with
DMARDs. Birth control is recommended during use of the DMARD leflunamide
(Arava®) because of its teratogenic effects. Corneal damage is possible with the
DMARD hydrochloroquine (Plaquenil®), but it is not related to use of Enbrel.
Reference: Drugs.com. (n.d.) Enbrel Dosage. Retrieved from
https://www.drugs.com/dosage/enbrel.html
QUESTIONS & ANSWERS 100%
CORRECT!!
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. - ANSWERb. 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." -
ANSWERc. "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 - ANSWERa. 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. - ANSWERb. 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 - ANSWERd. 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 - ANSWERc. 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. - ANSWERd. 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
A patient newly diagnosed with ankylosing spondylitis receives a prescription for
etanercept (Enbrel®). Which of the following statements should the nurse include in
patient teaching on this medication?
a. "This medication will be given once a week for your condition."
b. "This medication can cause GI upset and mild diarrhea."
c. "Be sure to use birth control while taking this Enbrel."
d. "Schedule an eye exam every year while taking Enbrel because of the risk of
corneal damage." - ANSWERa. "This medication will be given once a week for your
condition."
Rationale: Enbrel is typically prescribed for subcutaneous injection every week, with
the initial dose of 50 mg for ankylosing spondylitis. This biologic response modifier is
not likely to cause GI upset and diarrhea; these problems are more likely with
DMARDs. Birth control is recommended during use of the DMARD leflunamide
(Arava®) because of its teratogenic effects. Corneal damage is possible with the
DMARD hydrochloroquine (Plaquenil®), but it is not related to use of Enbrel.
Reference: Drugs.com. (n.d.) Enbrel Dosage. Retrieved from
https://www.drugs.com/dosage/enbrel.html
