Orthopaedic Nurse Certified (ONC) Exam — Questions and Answers

Question 1: Which bone is the largest and strongest bone in the human body?

Tibia
Humerus
Femur (Correct answer)
Pelvis

Correct answer: Femur

The femur (thigh bone) is the longest and strongest bone in the human body, bearing full body weight during ambulation.

Question 2: A patient recovering from total knee replacement is on a PCA (patient-controlled analgesia) pump with morphine. The nurse notes a respiratory rate of 8 breaths/min and pinpoint pupils. What is the priority intervention?

Increase the PCA basal rate
Administer naloxone (Narcan) as prescribed (Correct answer)
Reposition the patient and apply oxygen
Notify the surgeon and document findings

Correct answer: Administer naloxone (Narcan) as prescribed

Respiratory depression with pinpoint pupils indicates opioid toxicity; naloxone is the opioid antagonist that rapidly reverses this life-threatening complication.

Question 3: A patient develops HIT (heparin-induced thrombocytopenia) while receiving unfractionated heparin post-arthroplasty. What is the CORRECT management?

Switch to a lower dose of unfractionated heparin
Switch to low-molecular-weight heparin immediately
Transfuse platelets to maintain count above 50,000
Discontinue heparin and administer a direct thrombin inhibitor (Correct answer)

Correct answer: Discontinue heparin and administer a direct thrombin inhibitor

All heparin products must be stopped and replaced with a non-heparin anticoagulant such as argatroban or bivalirudin in HIT.

Question 4: A patient with total hip replacement is being discharged and does not understand precaution instructions despite verbal teaching. What is the next best step?

Document that teaching was completed
Use teach-back method, supplement with written instructions, and involve a family member if available (Correct answer)
Discharge the patient with written materials only
Request a social work consult to delay discharge

Correct answer: Use teach-back method, supplement with written instructions, and involve a family member if available

The teach-back method confirms comprehension and multi-modal reinforcement improves retention, especially for complex orthopaedic precautions.

Question 5: The ONC (Orthopaedic Nurse Certified) credential must be renewed every how many years?

2 years
3 years
10 years
5 years (Correct answer)

Correct answer: 5 years

NAON's ONC certification requires renewal every 5 years through continuing education or re-examination.

Question 6: Which type of continuing education activity is most likely to satisfy NAON's ONC renewal requirements?

General business management courses
Contact hours in musculoskeletal nursing practice (Correct answer)
Leadership courses from a non-nursing organization
Any accredited nursing course regardless of topic

Correct answer: Contact hours in musculoskeletal nursing practice

ONC renewal requires contact hours that are relevant to orthopaedic/musculoskeletal nursing to ensure maintenance of specialty-specific competency.

Question 7: A nurse is entering post-operative vital signs into the EHR and notices a previously entered value appears significantly abnormal. What is the APPROPRIATE action?

Leave the entry unchanged to avoid audit trail issues
Delete the entry without documentation
Contact the EHR vendor for system support
Compare to the original source (paper flowsheet, monitor strip) and correct with an addendum if needed (Correct answer)

Correct answer: Compare to the original source (paper flowsheet, monitor strip) and correct with an addendum if needed

Errors in the EHR should be corrected through an addendum or correction note after verifying against the original source, maintaining the integrity of the audit trail.

Question 8: A nurse is educating a patient on crutch walking using the 3-point gait after a non-weight-bearing right ankle fracture. The correct sequence is:

Left foot forward → both crutches forward → right foot lifts
Both crutches and right foot forward together → left foot advances (Correct answer)
Both crutches forward → right foot forward → left foot advances
Right foot → both crutches forward → left foot advances

Correct answer: Both crutches and right foot forward together → left foot advances

In 3-point gait, both crutches and the affected non-weight-bearing limb advance simultaneously, then the unaffected limb follows.

Question 9: Which class of medications works by inhibiting cyclooxygenase (COX) enzymes to reduce inflammation and pain in orthopaedic patients?

Opioid analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs) (Correct answer)
Muscle relaxants
Tricyclic antidepressants

Correct answer: Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs inhibit COX-1 and COX-2 enzymes, thereby reducing prostaglandin synthesis and decreasing inflammation, pain, and fever.

Question 10: An orthopaedic patient is receiving warfarin for DVT treatment. Which laboratory value is the primary parameter used to monitor therapeutic anticoagulation?

Anti-Xa level
Platelet count
International normalized ratio (INR) (Correct answer)
Activated partial thromboplastin time (aPTT)

Correct answer: International normalized ratio (INR)

The INR standardizes prothrombin time measurement across labs and is the gold-standard monitoring parameter for warfarin therapy.

Question 11: What is the importance of data security in Orthopaedic Nurse Test digital applications?

Security slows down work
Protecting sensitive information from unauthorized access, breaches, and loss is essential (Correct answer)
Security is unnecessary for professional data
Only financial data needs protection

Correct answer: Protecting sensitive information from unauthorized access, breaches, and loss is essential

This is fundamental to Orthopaedic Nurse Test practice. Protecting sensitive information from unauthorized access, breaches, and loss is essential represents the professional standard for technology in the Orthopaedic Nurse Test certification framework.

Question 12: A nurse is using a barcode medication administration (BCMA) system. Which step is ESSENTIAL before scanning the medication barcode?

Confirm the pharmacist has approved the order verbally
Verify the patient's room number verbally
Enter the medication name manually into the EHR
Scan the patient's identification wristband first (Correct answer)

Correct answer: Scan the patient's identification wristband first

Scanning the patient's wristband before the medication barcode ensures positive patient identification and links the medication scan to the correct patient record.

Question 13: A physical therapist reports that a post-knee arthroplasty patient refuses to ambulate. How should the orthopaedic nurse respond?

Notify the physician immediately without assessing the patient
Inform the patient that ambulation is mandatory for discharge
Assess the patient's pain level, address barriers, and collaborate with PT on a modified plan (Correct answer)
Document that the patient refused and take no further action

Correct answer: Assess the patient's pain level, address barriers, and collaborate with PT on a modified plan

Assessing pain and other barriers first allows the nurse to address underlying issues and collaborate interprofessionally on an achievable ambulation plan.

Question 14: During continuous passive motion (CPM) therapy after total knee arthroplasty, which parameter is MOST important for the nurse to monitor on the device display?

Battery charge level
Device manufacturer identification number
Network connectivity status
Range of motion settings and patient comfort (Correct answer)

Correct answer: Range of motion settings and patient comfort

The nurse must verify that ROM settings align with the surgeon's orders and continuously assess patient comfort and tolerance during CPM therapy.

Question 15: Which term describes the bone-forming cells responsible for synthesizing bone matrix?

Osteocytes
Chondrocytes
Osteoblasts (Correct answer)
Osteoclasts

Correct answer: Osteoblasts

Osteoblasts are bone-forming cells that synthesize and secrete the organic components of bone matrix, including type I collagen.

Question 16: 3D printing technology in orthopaedics is MOST commonly used in patient care for which purpose?

Fabricating disposable sterile gloves for the surgical team
Creating patient-specific surgical guides and custom implant models (Correct answer)
Printing medication tablets with customized doses
Generating electronic health records from voice dictation

Correct answer: Creating patient-specific surgical guides and custom implant models

3D printing enables creation of anatomically accurate patient-specific surgical cutting guides and pre-operative implant models that improve surgical precision.

Question 17: An orthopaedic patient develops acute confusion on postoperative day 2. Which assessment tool is MOST appropriate to use first?

Montreal Cognitive Assessment
Confusion Assessment Method (CAM) (Correct answer)
Glasgow Coma Scale
Mini-Mental State Examination

Correct answer: Confusion Assessment Method (CAM)

The CAM is a validated tool specifically designed to identify delirium in hospitalized patients.

Question 18: What distinguishes quality assurance from quality control in Orthopaedic Nurse Test practice?

QC is more important than QA
QA applies only to manufacturing
They are identical concepts
QA focuses on preventing defects through process improvement while QC detects defects through inspection (Correct answer)

Correct answer: QA focuses on preventing defects through process improvement while QC detects defects through inspection

This is fundamental to Orthopaedic Nurse Test practice. QA focuses on preventing defects through process improvement while QC detects defects through inspection represents the professional standard for quality in the Orthopaedic Nurse Test certification framework.

Question 19: Which muscle relaxant is commonly used in orthopaedic settings for acute musculoskeletal spasm and carries a risk of anticholinergic side effects?

Tizanidine (Zanaflex)
Baclofen
Cyclobenzaprine (Flexeril) (Correct answer)
Methocarbamol (Robaxin)

Correct answer: Cyclobenzaprine (Flexeril)

Cyclobenzaprine has a tricyclic structure and significant anticholinergic activity, causing dry mouth, urinary retention, and sedation, which nurses must monitor.

Question 20: A post-operative ACL repair patient tells the nurse they saw conflicting information online about their recovery protocol. The best response is to:

Acknowledge the confusion, clarify the prescribed protocol, and offer verified educational resources (Correct answer)
Advise the patient to stop using the internet for medical information
Explain that online sources are always unreliable
Tell the patient to bring the websites to the physician's attention

Correct answer: Acknowledge the confusion, clarify the prescribed protocol, and offer verified educational resources

Acknowledging patient research, clarifying evidence-based protocols, and providing reputable resources builds trust and reduces health misinformation harm.

Question 21: A 72-year-old patient with a total hip replacement is found sitting with the operative leg crossed over the non-operative leg. What is the priority nursing action?

Place the patient in Trendelenburg position to reduce joint stress
Document the position and notify the surgeon at the next scheduled round
Instruct the patient to uncross the legs immediately and reinforce hip precautions (Correct answer)
Apply a hip abduction pillow and continue monitoring

Correct answer: Instruct the patient to uncross the legs immediately and reinforce hip precautions

Crossing the legs after total hip replacement violates hip precautions and can cause dislocation; immediate correction and reinforcement of precautions is the priority.

Question 22: Which indicator is classified as a 'structure measure' in orthopaedic quality assurance?

Rate of surgical site infections per 100 procedures
Patient satisfaction scores for pain management
Time from surgery to first post-op ambulation
Percentage of nurses certified in orthopaedic nursing (ONC) (Correct answer)

Correct answer: Percentage of nurses certified in orthopaedic nursing (ONC)

Structure measures assess the capacity and resources of an organization, such as staff qualifications and certifications, that support quality care.

Question 23: Which federal law primarily governs the privacy of patient health information in orthopaedic practice settings?

HIPAA Privacy Rule (Correct answer)
Stark Law
EMTALA
False Claims Act

Correct answer: HIPAA Privacy Rule

HIPAA's Privacy Rule establishes national standards for protecting individually identifiable health information (PHI) in all healthcare settings, including orthopaedics.

Question 24: What is the first step in risk assessment for Orthopaedic Nurse Test professionals?

Delegating to others
Implementing controls immediately
Purchasing insurance
Identifying potential hazards and vulnerabilities in the specific context (Correct answer)

Correct answer: Identifying potential hazards and vulnerabilities in the specific context

This is fundamental to Orthopaedic Nurse Test practice. Identifying potential hazards and vulnerabilities in the specific context represents the professional standard for risk management in the Orthopaedic Nurse Test certification framework.

Question 25: Calcium carbonate and vitamin D3 supplements are prescribed for an orthopaedic patient post-vertebral fracture. For optimal calcium absorption, calcium carbonate should be taken:

At bedtime with a large glass of water
On an empty stomach one hour before meals
With meals or immediately after eating (Correct answer)
Two hours after taking any other medication

Correct answer: With meals or immediately after eating

Calcium carbonate requires gastric acid for dissolution and absorption; taking it with food stimulates acid secretion, significantly enhancing bioavailability.

Question 26: A continuous temperature monitoring system detects a spike in a patient's wound site after total knee arthroplasty. What is the MOST appropriate nursing response to this digital alert?

Administer antipyretics immediately per standing orders without assessment
Assess the wound site clinically and notify the surgeon of possible infection signs (Correct answer)
Document the alert only and re-evaluate at the next scheduled wound check
Reset the sensor and wait 30 minutes to see if the reading normalizes

Correct answer: Assess the wound site clinically and notify the surgeon of possible infection signs

A digital temperature alert for a wound site should prompt immediate hands-on clinical assessment for erythema, warmth, swelling, or drainage, with timely provider notification.

Question 27: Robotic-assisted surgery systems used in total knee arthroplasty primarily benefit patients by:

Replacing the surgeon's decision-making with artificial intelligence
Improving implant positioning accuracy through real-time haptic feedback and pre-operative planning (Correct answer)
Reducing surgical time by automating the entire procedure
Eliminating the need for post-operative physical therapy

Correct answer: Improving implant positioning accuracy through real-time haptic feedback and pre-operative planning

Robotic-assisted systems like MAKO use CT-based pre-operative plans and real-time haptic boundaries to improve the accuracy of bone resection and implant alignment.

Question 28: What role does active listening play in Orthopaedic Nurse Test practice?

It means staying silent
It ensures accurate understanding, demonstrates respect, and improves outcomes (Correct answer)
It wastes time
It is only for counseling professionals

Correct answer: It ensures accurate understanding, demonstrates respect, and improves outcomes

This is fundamental to Orthopaedic Nurse Test practice. It ensures accurate understanding, demonstrates respect, and improves outcomes represents the professional standard for communication in the Orthopaedic Nurse Test certification framework.

Question 29: An orthopaedic nurse is using a digital pain assessment tool on a tablet that incorporates a visual analog scale (VAS). What advantage does the digital VAS offer over a paper version?

It allows direct data entry into the EHR, reducing transcription errors (Correct answer)
It replaces the nurse's clinical judgment about pain management
It automatically administers analgesics based on the score
It eliminates the need to assess pain altogether

Correct answer: It allows direct data entry into the EHR, reducing transcription errors

Digital VAS tools that integrate with the EHR allow pain scores to be entered directly into the patient record, avoiding transcription errors and supporting longitudinal tracking.

Question 30: A systematic review on orthopaedic wound care reports an I² statistic of 85%. This indicates:

High consistency across studies
The intervention is 85% effective
85% of studies are at low risk of bias
High statistical heterogeneity among included studies (Correct answer)

Correct answer: High statistical heterogeneity among included studies

An I² of 85% reflects high heterogeneity, meaning the included studies vary substantially in their results.

Question 31: Which type of fracture is characterized by the bone being crushed or compressed, commonly seen in vertebral injuries?

Spiral fracture
Transverse fracture
Greenstick fracture
Compression fracture (Correct answer)

Correct answer: Compression fracture

A compression fracture occurs when bone is crushed under excessive axial force, frequently affecting vertebral bodies in osteoporotic patients.

Question 32: An orthopaedic nurse reviews two studies on early mobilization after hip fracture. Study A has a small sample and wide confidence intervals; Study B has a large sample and narrow confidence intervals. Which study provides more precise estimates?

Study A, because fewer confounders are present
Study A, because smaller studies are less biased
Both equally, as p-values determine precision
Study B, because larger samples yield narrower confidence intervals (Correct answer)

Correct answer: Study B, because larger samples yield narrower confidence intervals

Larger sample sizes produce narrower confidence intervals, indicating more precise and reliable estimates of effect.

Question 33: A patient with a long leg cast reports intense pain, pallor, and pulselessness in the foot. The nurse's FIRST action should be:

Apply a warm compress to improve circulation
Notify the surgeon immediately (Correct answer)
Administer prescribed analgesics and reassess in 30 minutes
Elevate the limb above heart level

Correct answer: Notify the surgeon immediately

Signs of acute compartment syndrome or vascular compromise require immediate surgical notification as this is a limb-threatening emergency.

Question 34: An orthopaedic nurse who preceptors new staff is functioning in which professional role?

Administrator
Researcher
Case manager
Educator (Correct answer)

Correct answer: Educator

Acting as a preceptor is a core function of the educator role, supporting knowledge transfer and professional development.

Question 35: A patient 3 days post-ORIF of a femur fracture reports sudden onset of chest pain and dyspnea. Oxygen saturation drops to 88%. What should the nurse do first?

Administer supplemental oxygen and call a rapid response (Correct answer)
Reposition the patient to the side-lying position
Increase IV fluid rate to maintain perfusion
Administer prescribed analgesic to rule out musculoskeletal cause

Correct answer: Administer supplemental oxygen and call a rapid response

These signs in a post-operative orthopaedic patient suggest pulmonary embolism; immediate oxygen and rapid response activation are the priority actions.

Question 36: Which non-pharmacological pain management strategy is considered first-line complementary care for acute post-operative orthopaedic pain?

Cryotherapy (ice application) to reduce swelling and pain (Correct answer)
Guided imagery and progressive muscle relaxation alone
Transcutaneous electrical nerve stimulation (TENS) at the incision
Therapeutic massage over the surgical incision site

Correct answer: Cryotherapy (ice application) to reduce swelling and pain

Cryotherapy reduces local edema, slows nerve conduction, and decreases metabolic activity at the surgical site, providing effective non-opioid analgesic benefit.

Question 37: Which nutritional element is most important to support bone healing following an orthopaedic fracture?

Calcium and Vitamin D (Correct answer)
Magnesium and potassium
Vitamin C and iron
Zinc and Vitamin B12

Correct answer: Calcium and Vitamin D

Calcium provides the mineral matrix for bone healing while Vitamin D facilitates calcium absorption; both are essential for fracture repair and bone remodeling.

Question 38: Which classification system is most commonly used to assess the severity of open fractures?

Neer classification
Weber classification
Garden classification
Gustilo-Anderson classification (Correct answer)

Correct answer: Gustilo-Anderson classification

The Gustilo-Anderson classification grades open fractures I–III based on wound size, contamination, and soft tissue damage to guide management.

Question 39: A nurse notices a colleague documenting care that was not performed. The most appropriate action is to:

Report the concern through the appropriate chain of command or ethics process (Correct answer)
Ignore the behavior since it does not involve the nurse's own patients
Correct the colleague's documentation yourself
Post about it on social media to raise awareness

Correct answer: Report the concern through the appropriate chain of command or ethics process

Falsified documentation is a patient safety and professional ethics issue that must be reported through established institutional and regulatory channels.

Question 40: A patient scheduled for hip replacement surgery expresses fear about anesthesia. Which communication strategy is most effective?

Tell the patient not to worry because the surgeon is experienced
Acknowledge the fear, provide factual information, and offer to involve the anesthesiologist (Correct answer)
Reassure the patient that anesthesia is always safe
Document the concern and notify the charge nurse

Correct answer: Acknowledge the fear, provide factual information, and offer to involve the anesthesiologist

Acknowledging the patient's fear validates their feelings, while providing facts and involving the specialist addresses the root concern appropriately.

Question 41: During a journal club reviewing a hip arthroplasty study, a nurse notes the control group received usual care while the intervention group received structured physiotherapy. This study design is best described as:

Qualitative phenomenology
Randomized controlled trial (Correct answer)
Case-control study
Cross-sectional survey

Correct answer: Randomized controlled trial

An RCT involves random allocation to intervention and control groups to evaluate the effect of an intervention.

Question 42: Which aspect of the Health Insurance Portability and Accountability Act (HIPAA) most directly governs how orthopaedic nurses handle digital patient records?

The Documentation Rule specifying minimum charting intervals
The Security Rule mandating safeguards for electronic protected health information (ePHI) (Correct answer)
The Staffing Rule dictating nurse-to-patient ratios
The Billing Rule requiring timely submission of insurance claims

Correct answer: The Security Rule mandating safeguards for electronic protected health information (ePHI)

HIPAA's Security Rule requires administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of electronic protected health information.

Question 43: A patient asks the orthopaedic nurse to keep a conversation about medication side effects private from their spouse. The nurse should:

Respect the patient's confidentiality request, as patients have the right to control their own health information (Correct answer)
Document that the patient is withholding information from family
Consult the ethics team before agreeing to confidentiality
Inform the spouse anyway since they are the primary caregiver

Correct answer: Respect the patient's confidentiality request, as patients have the right to control their own health information

HIPAA protects each patient's right to determine who receives their health information, regardless of relationship to the patient.

Question 44: Which cybersecurity practice is MOST critical when an orthopaedic nurse accesses the EHR on a shared workstation?

Disabling the screen lock to speed up workflow
Logging out of the EHR immediately after completing documentation (Correct answer)
Sharing login credentials with other nurses during busy shifts
Saving the patient's record to the desktop for quick access

Correct answer: Logging out of the EHR immediately after completing documentation

Logging out after each use prevents unauthorized access to protected health information (PHI) by subsequent users of shared workstations.

Question 45: A patient's spouse becomes hostile when told visiting hours have ended. What is the best initial response?

Calmly acknowledge the spouse's concern, explain the policy rationale, and offer alternative communication options (Correct answer)
Threaten to ban the spouse from the unit
Call security immediately
Ignore the behavior and walk away

Correct answer: Calmly acknowledge the spouse's concern, explain the policy rationale, and offer alternative communication options

De-escalation begins with calm acknowledgment and clear explanation, which reduces defensiveness and opens dialogue without escalating conflict.

Question 46: Which anticoagulant is most commonly prescribed for venous thromboembolism (VTE) prophylaxis after total hip arthroplasty?

Rivaroxaban (Xarelto) (Correct answer)
Aspirin 325 mg twice daily
Clopidogrel (Plavix)
Heparin (unfractionated)

Correct answer: Rivaroxaban (Xarelto)

Rivaroxaban, a direct factor Xa inhibitor, is widely used for VTE prophylaxis after major joint replacement due to its predictable pharmacokinetics and oral route.

Question 47: An orthopaedic unit nurse disagrees with a physician's order for early weight-bearing in a patient with a tibial plateau fracture. What is the appropriate action?

Voice the concern directly to the physician using assertive communication, document the exchange (Correct answer)
Ask another nurse to implement the order
Refuse to carry out the order until it is reviewed
Follow the order without question since the physician is responsible

Correct answer: Voice the concern directly to the physician using assertive communication, document the exchange

Assertive, respectful communication of clinical concerns is a professional responsibility; documenting the exchange creates an accountability record.

Question 48: When teaching a patient non-weight-bearing (NWB) crutch walking, the nurse instructs the patient to bear weight through which body part?

Wrists
Hands and arms only (Correct answer)
Operative foot only
Axillae (armpits)

Correct answer: Hands and arms only

Non-weight-bearing crutch walking requires all weight bearing through the hands and arms; the axillae must NOT bear weight as this causes axillary nerve damage.

Question 49: What is the primary purpose of regulatory compliance in Orthopaedic Nurse Test practice?

To create bureaucratic burden
To limit competition
To protect public safety, ensure quality standards, and maintain professional accountability (Correct answer)
To benefit regulators only

Correct answer: To protect public safety, ensure quality standards, and maintain professional accountability

This is fundamental to Orthopaedic Nurse Test practice. To protect public safety, ensure quality standards, and maintain professional accountability represents the professional standard for regulatory in the Orthopaedic Nurse Test certification framework.

Question 50: A surgeon orders prophylactic cefazolin 2 g IV for a patient undergoing spinal fusion. When should this antibiotic be administered to achieve optimal tissue levels?

At the conclusion of the surgical procedure
Within 60 minutes before surgical incision (Correct answer)
Immediately after the surgical incision is made
24 hours before the scheduled procedure

Correct answer: Within 60 minutes before surgical incision

SCIP (Surgical Care Improvement Project) guidelines specify antibiotic prophylaxis must be infused within 60 minutes before incision to ensure adequate tissue concentration at the time of skin breach.

Question 51: Which food or drug interaction is most clinically significant for a patient taking warfarin after orthopaedic surgery?

Calcium supplements potentiate warfarin and increase bleeding risk
High-protein diets increase warfarin absorption and risk of bleeding
Vitamin K-rich foods (e.g., leafy greens) can reduce warfarin's effect (Correct answer)
Grapefruit juice increases warfarin clearance, reducing anticoagulation

Correct answer: Vitamin K-rich foods (e.g., leafy greens) can reduce warfarin's effect

Vitamin K is a cofactor for clotting factor synthesis and directly antagonizes warfarin's mechanism, so large or inconsistent intake of vitamin K-rich foods destabilizes INR control.

Question 52: A patient with a hip fracture has an epidural catheter for pain management. The nurse notes hypotension and lower extremity weakness. What is the most appropriate initial nursing action?

Administer a bolus of the epidural medication
Reposition the patient to the prone position
Increase the epidural infusion rate
Stop the epidural infusion and notify the provider (Correct answer)

Correct answer: Stop the epidural infusion and notify the provider

Hypotension from sympathetic blockade and motor weakness from local anesthetic spread are serious epidural complications requiring immediate cessation of the infusion and provider notification.

Question 53: Compartment syndrome is best confirmed by which assessment finding?

Skin pallor over the affected limb
Patient report of numbness only
Moderate swelling with intact distal pulses
Pain out of proportion to injury with pain on passive stretch (Correct answer)

Correct answer: Pain out of proportion to injury with pain on passive stretch

The hallmark signs of acute compartment syndrome are pain disproportionate to the injury and pain elicited by passive stretch of muscles in the affected compartment.

Question 54: What is the significance of a code of conduct for Orthopaedic Nurse Test professionals?

It applies only to new practitioners
It establishes expected behaviors and ethical standards that protect the public and profession (Correct answer)
It is merely symbolic
It limits professional freedom

Correct answer: It establishes expected behaviors and ethical standards that protect the public and profession

This is fundamental to Orthopaedic Nurse Test practice. It establishes expected behaviors and ethical standards that protect the public and profession represents the professional standard for professional standards in the Orthopaedic Nurse Test certification framework.

Question 55: A patient undergoing total knee replacement receives a femoral nerve block pre-operatively. The primary purpose of this regional anesthetic technique is to:

Prevent surgical site infection
Reduce intraoperative blood loss
Ensure complete intraoperative anesthesia without general anesthesia
Provide postoperative analgesia and reduce opioid consumption (Correct answer)

Correct answer: Provide postoperative analgesia and reduce opioid consumption

Femoral nerve blocks reduce post-operative pain and opioid requirements, facilitating earlier mobilization and reducing opioid-related side effects after TKA.

Question 56: The right foot is polydactyl when a baby is born, although there is no bone involvement. The best course of action at this time would be

tie off the extra digit with a silk suture or vascular clip (Correct answer)
clip off the extra digit as there is no bony involvement
no treatment at this time
surgery to remove the extra digit

Correct answer: tie off the extra digit with a silk suture or vascular clip

When a polydactyl digit (extra digit) has no bone involvement, it is typically a soft tissue tag. Tying off the digit at its base with a silk suture or vascular clip restricts blood flow, causing the tissue to necrose and fall off naturally within a few days or weeks. This is a simple, non-surgical procedure that avoids the risks associated with surgical excision for a non-bony appendage.

Question 57: Which technology is commonly used in the operating room to provide real-time intraoperative imaging guidance during orthopaedic procedures such as spinal fusion?

PET scan
Ultrasound elastography
Fluoroscopy (C-arm) (Correct answer)
DEXA scan

Correct answer: Fluoroscopy (C-arm)

Fluoroscopy using a C-arm provides real-time X-ray imaging during procedures, enabling surgeons to confirm implant placement and alignment intraoperatively.

Question 58: The Lachman test is used to assess the integrity of which structure?

Medial collateral ligament
Lateral meniscus
Posterior cruciate ligament
Anterior cruciate ligament (Correct answer)

Correct answer: Anterior cruciate ligament

The Lachman test evaluates anterior cruciate ligament (ACL) integrity by assessing anterior tibial translation with the knee at 20–30° of flexion.

Question 59: A nurse reviews an article where participants were not told whether they received real or sham ultrasound therapy for bone healing. This describes which type of blinding?

Double-blind
Single-blind (Correct answer)
Triple-blind
Open-label

Correct answer: Single-blind

Single-blind means only the participants are unaware of their group assignment, while researchers know the allocation.

Question 60: A patient with a right total hip replacement (posterior approach) is being discharged. Which adaptive equipment is most important to prevent dislocation?

Continuous ice therapy unit
Raised toilet seat (Correct answer)
Knee immobilizer brace
Sequential compression device

Correct answer: Raised toilet seat

A raised toilet seat keeps hip flexion under 90°, preventing posterior dislocation of a total hip prosthesis during the critical early recovery period.

Question 61: During a care conference for a post-operative spinal fusion patient, the family disagrees with the discharge plan. What is the nurse's priority action?

Listen to the family's concerns and facilitate a discussion with the multidisciplinary team (Correct answer)
Ask the family to submit their concerns in writing
Reassure the family that the plan is standard protocol
Proceed with discharge as ordered by the physician

Correct answer: Listen to the family's concerns and facilitate a discussion with the multidisciplinary team

Facilitating multidisciplinary dialogue ensures all stakeholder perspectives are heard and incorporated into a safe, patient-centered discharge plan.

Question 62: A nurse implementing EBP notices that staff resist adopting a new evidence-based wound dressing protocol. The most effective strategy to overcome this barrier is to:

Mandate immediate compliance with no discussion
Eliminate the old protocol from written policy only
Engage frontline staff in reviewing evidence and adapting the protocol (Correct answer)
Wait until staff voluntarily adopt the change

Correct answer: Engage frontline staff in reviewing evidence and adapting the protocol

Engaging frontline nurses in reviewing the evidence and co-developing the protocol increases ownership and reduces resistance to change.

Question 63: Which action by an orthopaedic nurse best demonstrates culturally competent communication?

Asking patients about their cultural beliefs regarding pain and treatment, and incorporating these into the care plan (Correct answer)
Using medical terminology consistently to maintain professionalism
Treating all patients the same regardless of background
Relying on visual aids to eliminate the need for verbal communication

Correct answer: Asking patients about their cultural beliefs regarding pain and treatment, and incorporating these into the care plan

Asking patients directly about their beliefs and incorporating responses into care planning is the hallmark of culturally competent, individualized care.

Question 64: The patella is classified as which type of bone?

Sesamoid bone (Correct answer)
Long bone
Short bone
Flat bone

Correct answer: Sesamoid bone

The patella is the largest sesamoid bone in the body, embedded within the quadriceps tendon to improve mechanical advantage at the knee.

Question 65: How should Orthopaedic Nurse Test professionals handle conflicts with stakeholders?

Escalate immediately to management
Address issues professionally through active listening, finding common ground, and seeking resolution (Correct answer)
Avoid all conflict
Ignore stakeholder concerns

Correct answer: Address issues professionally through active listening, finding common ground, and seeking resolution

This is fundamental to Orthopaedic Nurse Test practice. Address issues professionally through active listening, finding common ground, and seeking resolution represents the professional standard for communication in the Orthopaedic Nurse Test certification framework.

Question 66: Which nursing behavior best promotes psychological safety on an orthopaedic unit?

Maintaining strict hierarchy so junior staff always defer to senior nurses
Limiting team discussions to prevent information overload
Actively inviting input from all team members and responding non-defensively to concerns (Correct answer)
Keeping communication formal and task-focused during high-stress periods

Correct answer: Actively inviting input from all team members and responding non-defensively to concerns

Psychological safety is built when team members feel their input is welcomed and that raising concerns will not lead to punishment or ridicule.

Question 67: Which type of imaging technology uses magnetic fields and radio waves to produce detailed images of soft tissue around bones?

Fluoroscopy
Magnetic Resonance Imaging (MRI) (Correct answer)
Dual-energy X-ray Absorptiometry (DEXA)
Computed Tomography (CT)

Correct answer: Magnetic Resonance Imaging (MRI)

MRI uses magnetic fields and radio waves, making it superior for visualizing soft tissues, cartilage, and ligaments surrounding orthopaedic structures.

Question 68: An orthopaedic nurse is caring for a patient who speaks limited English and is accompanied by a bilingual minor child. Consent for a procedure is needed. The nurse should:

Postpone the procedure until an adult interpreter is available in person
Contact the hospital's interpreter services or use a certified telephonic interpreter (Correct answer)
Document that the patient consented using the child as interpreter
Allow the child to translate since the parent is present

Correct answer: Contact the hospital's interpreter services or use a certified telephonic interpreter

Using a certified medical interpreter, including telephonic services, ensures accurate communication without placing the burden on a minor child.

Question 69: An orthopaedic nurse calculates a Number Needed to Treat (NNT) of 4 for a compression bandage protocol. This means:

4% of patients benefit from the treatment
The treatment is 4 times more effective than placebo
4 adverse events occurred per treatment
4 patients must be treated for 1 to benefit (Correct answer)

Correct answer: 4 patients must be treated for 1 to benefit

NNT of 4 means 4 patients need to receive the intervention for one additional patient to benefit compared to control.

Question 70: Which federal act protects orthopaedic nurses who report patient safety violations or participate in investigations from employer retaliation?

National Labor Relations Act (NLRA) only
Fair Labor Standards Act (FLSA)
Family and Medical Leave Act (FMLA)
Occupational Safety and Health Act whistleblower protection provisions (Correct answer)

Correct answer: Occupational Safety and Health Act whistleblower protection provisions

Section 11(c) of the OSH Act and several other federal statutes prohibit employers from retaliating against employees who report safety violations or participate in regulatory investigations.

Question 71: A bisphosphonate such as alendronate is prescribed for an orthopaedic patient with osteoporosis. Which instruction is most important to include in patient teaching?

Crush the tablet if swallowing is difficult
Take at bedtime to reduce GI side effects
Remain upright for at least 30 minutes after taking (Correct answer)
Take with a full glass of milk to enhance absorption

Correct answer: Remain upright for at least 30 minutes after taking

Bisphosphonates can cause esophageal irritation and esophagitis; patients must remain upright for 30–60 minutes after ingestion to prevent reflux and mucosal damage.

Question 72: A post-operative patient with a spinal fusion at L4-L5 is being assisted to sit at the edge of the bed for the first time. She reports severe dizziness. What is the priority nursing action?

Administer prescribed antiemetic before attempting to re-dangle
Lower the head of the bed and place the patient in Trendelenburg position immediately
Return the patient to the supine position, assess vital signs, and have her sit up slowly after symptoms resolve (Correct answer)
Encourage the patient to breathe deeply and push through the dizziness to prevent deconditioning

Correct answer: Return the patient to the supine position, assess vital signs, and have her sit up slowly after symptoms resolve

Orthostatic hypotension is common after spinal surgery; returning to supine and reassessing before re-attempting dangling prevents falls and injury.

Question 73: Which anticoagulation agent is most commonly used for DVT prophylaxis following total knee replacement in the US?

Warfarin or a direct oral anticoagulant (DOAC) (Correct answer)
Aspirin 81mg only
Clopidogrel
Heparin infusion

Correct answer: Warfarin or a direct oral anticoagulant (DOAC)

AAOS and ACCP guidelines recommend warfarin or DOACs (e.g., rivaroxaban, apixaban) as standard DVT prophylaxis after total knee arthroplasty.

Question 74: Which type of bone fracture in children occurs on one cortex only, with the other side bending but not breaking?

Physeal fracture
Greenstick fracture (Correct answer)
Comminuted fracture
Torus fracture

Correct answer: Greenstick fracture

A greenstick fracture affects one cortex while the opposite cortex bends, occurring in children whose bones are more flexible than adult bone.

Question 75: A newly hired orthopaedic nurse is unsure how to communicate a clinical concern to the attending physician. Which resource best supports safe communication?

Waiting until the next physician rounding to raise all concerns at once
Personal judgment about when concerns are serious enough to report
Texting the concern informally to the team
Unit-specific communication protocols and mentorship from experienced staff (Correct answer)

Correct answer: Unit-specific communication protocols and mentorship from experienced staff

Unit protocols and mentorship provide new nurses with safe, structured pathways for communicating clinical concerns appropriately.

Question 76: What role does data analytics play in Orthopaedic Nurse Test practice?

It replaces professional judgment
It is only for IT professionals
It supports evidence-based decision making by identifying patterns and trends in relevant data (Correct answer)
It creates unnecessary complexity

Correct answer: It supports evidence-based decision making by identifying patterns and trends in relevant data

This is fundamental to Orthopaedic Nurse Test practice. It supports evidence-based decision making by identifying patterns and trends in relevant data represents the professional standard for technology in the Orthopaedic Nurse Test certification framework.

Question 77: A patient on patient-controlled analgesia (PCA) asks why family members are not allowed to press the PCA button. The best nursing explanation is:

The pump requires a special PIN that only the nurse knows
Family members may administer medication too slowly
Only the patient can assess their own pain level, preventing overdose (Correct answer)
Hospital policy prohibits it to reduce medication waste

Correct answer: Only the patient can assess their own pain level, preventing overdose

PCA safety relies on the patient being alert enough to self-administer; a sedated patient will not press the button, providing a built-in safety mechanism that is bypassed when others press it.

Question 78: Gabapentin (Neurontin) is sometimes used as part of multimodal analgesia in orthopaedic surgery. Its primary mechanism of action is:

Mu-opioid receptor agonism
Inhibition of COX-1 and COX-2 enzymes
Antagonism of NMDA glutamate receptors
Binding to alpha-2-delta subunits of voltage-gated calcium channels (Correct answer)

Correct answer: Binding to alpha-2-delta subunits of voltage-gated calcium channels

Gabapentin binds to the alpha-2-delta subunit of voltage-gated calcium channels in the CNS, reducing neuronal excitability and central sensitization to pain.

Question 79: What is the primary purpose of sequential compression devices (SCDs) in post-operative orthopaedic patients?

Prevent deep vein thrombosis by improving venous return (Correct answer)
Decrease peripheral edema from fluid resuscitation
Reduce post-operative pain
Maintain limb temperature and perfusion

Correct answer: Prevent deep vein thrombosis by improving venous return

SCDs apply intermittent pneumatic compression to the legs to simulate muscle pump action and prevent venous stasis.

Question 80: Which laboratory value is MOST critical to monitor in a patient receiving anticoagulation therapy after orthopaedic surgery?

Serum creatinine
Hemoglobin A1c
Serum albumin
International Normalized Ratio (INR) (Correct answer)

Correct answer: International Normalized Ratio (INR)

INR reflects the degree of anticoagulation with warfarin and must be monitored closely to prevent bleeding or clot formation.

Question 81: Which condition is an absolute contraindication to the use of NSAIDs in an orthopaedic patient?

Post-operative day 3 after hip replacement
Mild osteoarthritis
Severe renal impairment (CrCl < 30 mL/min) (Correct answer)
Chronic low back pain

Correct answer: Severe renal impairment (CrCl < 30 mL/min)

NSAIDs reduce renal prostaglandin synthesis, decreasing glomerular filtration; in patients with severe renal impairment, this can precipitate acute kidney injury.

Question 82: A patient with a long arm cast for a humerus fracture is being discharged. Which instruction is most important to include?

Avoid elevating the arm above shoulder height for 6 weeks
Remove the cast weekly for hygiene and reapply it snugly
Keep the arm dependent to reduce swelling around the fracture site
Return immediately if fingers become numb, blue, or you cannot move them (Correct answer)

Correct answer: Return immediately if fingers become numb, blue, or you cannot move them

Numbness, color change, or inability to move digits are signs of neurovascular compromise requiring immediate evaluation.

Question 83: Which complication is specifically associated with prolonged use of a tight plaster cast on a limb?

Avascular necrosis
Compartment syndrome (Correct answer)
Fat embolism
Osteomyelitis

Correct answer: Compartment syndrome

A cast that is too tight can impede circulation and increase compartmental pressure, leading to acute compartment syndrome if not recognized and treated promptly.

Question 84: A patient with a pelvic fracture is noted to have gross hematuria and a distended abdomen. Blood pressure is 88/54 mmHg. What is the nurse's priority action?

Apply a pelvic binder and transfer to CT immediately
Activate the trauma response, initiate large-bore IV access, and prepare for fluid resuscitation (Correct answer)
Administer prescribed analgesics and recheck vital signs in 15 minutes
Insert a urinary catheter to monitor urine output and assess for ongoing bleeding

Correct answer: Activate the trauma response, initiate large-bore IV access, and prepare for fluid resuscitation

Hemodynamic instability with internal bleeding signs requires immediate trauma team activation and resuscitation before other interventions.

Question 85: Which database is considered the most comprehensive source for retrieving peer-reviewed orthopaedic nursing research?

Google Scholar only
Wikipedia
Textbook appendices
MEDLINE/PubMed (Correct answer)

Correct answer: MEDLINE/PubMed

MEDLINE/PubMed is the premier biomedical database providing access to peer-reviewed nursing and medical literature.

Question 86: A nurse evaluates a clinical practice guideline for post-fracture osteoporosis management. The GRADE system is used to:

Rate the quality and strength of evidence behind recommendations (Correct answer)
Determine statistical significance
Assign authorship credit to researchers
Calculate sample size requirements

Correct answer: Rate the quality and strength of evidence behind recommendations

The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system classifies the quality of evidence and strength of clinical recommendations.

Question 87: Wolff's Law states that bone will adapt its structure in response to which factor?

Mechanical loads placed upon it (Correct answer)
Hormonal fluctuations
Vitamin D intake
Blood calcium levels

Correct answer: Mechanical loads placed upon it

Wolff's Law states that bone remodels and strengthens in response to mechanical stress, which is why weight-bearing exercise improves bone density.

Question 88: When administering ketorolac (Toradol) to a post-operative orthopaedic patient, the nurse should be most concerned about which potential complication with prolonged use?

Hypertensive crisis
Respiratory depression
Hepatotoxicity and jaundice
Gastrointestinal bleeding and renal impairment (Correct answer)

Correct answer: Gastrointestinal bleeding and renal impairment

Ketorolac is an NSAID that inhibits prostaglandin synthesis, increasing risk of GI bleeding and reducing renal perfusion, particularly with use beyond 5 days.

Question 89: A nurse is preparing to apply a figure-8 bandage to a patient's clavicle fracture. The PRIMARY goal of this bandage is to:

Immobilize the shoulder completely
Provide compression to control bleeding
Prevent pneumothorax complications
Retract the shoulders to reduce fracture displacement (Correct answer)

Correct answer: Retract the shoulders to reduce fracture displacement

A figure-8 clavicle bandage holds the shoulders back, pulling the clavicle fragments into better alignment by retracting the shoulder girdle.

Question 90: The 'unhappy triad' knee injury involves damage to which three structures?

PCL, LCL, and lateral meniscus
MCL, LCL, and ACL
ACL, MCL, and medial meniscus (Correct answer)
ACL, PCL, and lateral meniscus

Correct answer: ACL, MCL, and medial meniscus

The unhappy triad (O'Donoghue triad) involves simultaneous injury to the ACL, MCL, and medial meniscus, typically from a valgus force to the knee.

Question 91: An orthopaedic nurse needs to hand off a patient with a newly placed external fixator to the oncoming shift. Which handoff element is most critical?

Pin site condition, neurovascular status, and weight-bearing restrictions (Correct answer)
Family visitation preferences
Patient's insurance information
Patient's preferred meal times

Correct answer: Pin site condition, neurovascular status, and weight-bearing restrictions

Pin site status, neurovascular checks, and weight-bearing orders are safety-critical details that prevent complications in external fixator patients.

Question 92: Which action by a nurse demonstrates adherence to the standard of professional practice evaluation (peer review)?

Providing and receiving constructive feedback on clinical performance with colleagues (Correct answer)
Avoiding feedback conversations to maintain unit harmony
Reporting peers only when patient harm has occurred
Reviewing only self-identified errors

Correct answer: Providing and receiving constructive feedback on clinical performance with colleagues

Peer review involves mutual, constructive evaluation of practice to promote continuous professional growth and safe patient care.

Question 93: Which of the following BEST describes the purpose of continuous passive motion (CPM) after total knee arthroplasty?

Strengthen quadriceps muscles
Reduce postoperative swelling only
Prevent deep vein thrombosis
Promote joint mobility and prevent adhesions (Correct answer)

Correct answer: Promote joint mobility and prevent adhesions

CPM maintains range of motion and prevents fibrous adhesions in the joint while the patient is recovering from TKA.

Question 94: What is a compliance management system in Orthopaedic Nurse Test practice?

A government reporting requirement
A structured framework of policies, procedures, and controls that ensure regulatory adherence (Correct answer)
An optional business tool
A software application only

Correct answer: A structured framework of policies, procedures, and controls that ensure regulatory adherence

This is fundamental to Orthopaedic Nurse Test practice. A structured framework of policies, procedures, and controls that ensure regulatory adherence represents the professional standard for regulatory in the Orthopaedic Nurse Test certification framework.

Question 95: Which tool is commonly used for root cause analysis in Orthopaedic Nurse Test quality management?

Fishbone (Ishikawa) diagram to identify contributing factors systematically (Correct answer)
Random sampling
Customer surveys only
Profit analysis

Correct answer: Fishbone (Ishikawa) diagram to identify contributing factors systematically

This is fundamental to Orthopaedic Nurse Test practice. Fishbone (Ishikawa) diagram to identify contributing factors systematically represents the professional standard for quality in the Orthopaedic Nurse Test certification framework.

Question 96: The menisci of the knee serve which primary function?

Produce synovial fluid
Prevent posterior tibial displacement
Absorb shock and distribute load across the knee joint (Correct answer)
Connect the femur to the tibia

Correct answer: Absorb shock and distribute load across the knee joint

The medial and lateral menisci act as shock absorbers and load distributors, reducing stress on articular cartilage within the knee joint.

Question 97: Which ligament of the knee prevents anterior displacement of the tibia on the femur?

Posterior cruciate ligament
Anterior cruciate ligament (Correct answer)
Lateral collateral ligament
Medial collateral ligament

Correct answer: Anterior cruciate ligament

The anterior cruciate ligament (ACL) resists anterior tibial translation and rotational forces, making it a critical stabilizer of the knee.

Question 98: Contraindications to ultrasound therapy include

bursitis
a muscle sprain
a sprain
a suspected fracture (Correct answer)

Correct answer: a suspected fracture

Ultrasound therapy generates heat and mechanical vibrations that can potentially disrupt the healing process of a fracture or worsen an undiagnosed one. Applying ultrasound to a suspected fracture site could delay proper diagnosis, cause further injury, or interfere with bone alignment and healing. Therefore, it is a contraindication to prevent complications and ensure patient safety.

Question 99: A nurse reads a case-control study investigating risk factors for surgical site infection (SSI) after spinal fusion. Cases are patients with SSI and controls are those without. The measure of association reported is:

Hazard ratio
Odds ratio (Correct answer)
Relative risk
Number needed to harm

Correct answer: Odds ratio

Case-control studies report odds ratios because they cannot directly calculate incidence rates from retrospective data.

Question 100: What is the benefit of standardized digital reporting in Orthopaedic Nurse Test practice?

It replaces professional communication
It limits creativity
It ensures consistency, enables comparison, and facilitates regulatory compliance (Correct answer)
It is only needed for government work

Correct answer: It ensures consistency, enables comparison, and facilitates regulatory compliance

This is fundamental to Orthopaedic Nurse Test practice. It ensures consistency, enables comparison, and facilitates regulatory compliance represents the professional standard for technology in the Orthopaedic Nurse Test certification framework.

Question 101: A patient reports a sudden 'popping' sensation in the hip 2 days after total hip arthroplasty and cannot bear weight. X-ray confirms dislocation. What pre-reduction nursing priority applies?

Keep the patient NPO and prepare for conscious sedation or surgical reduction (Correct answer)
Administer IV opioids and attempt gentle passive range of motion
Position the patient with the hip flexed at 90 degrees while awaiting the surgeon
Apply manual traction to the limb to reduce the dislocation at bedside

Correct answer: Keep the patient NPO and prepare for conscious sedation or surgical reduction

Hip dislocation requires closed or open reduction under sedation or anesthesia; keeping the patient NPO prepares for the procedure safely.

Question 102: In orthopaedic quality assurance, 'benchmarking' refers to which activity?

Comparing unit performance metrics against internal or external standards (Correct answer)
Measuring the angle of a patient's joint range of motion
Establishing a new policy based on staff feedback
Setting a minimum score on a nursing competency test

Correct answer: Comparing unit performance metrics against internal or external standards

Benchmarking involves measuring a unit's performance against best-practice standards or comparable institutions to identify improvement opportunities.

Question 103: Under CMS Conditions of Participation, a hospital's restraint policy for an agitated post-operative orthopaedic patient must include which requirement?

A current physician order before or as soon as possible after applying restraints, with reassessment per policy (Correct answer)
Physician order obtained within 24 hours after restraint application
Restraint use approved by the hospital ethics committee
Family consent obtained before any restraint is applied

Correct answer: A current physician order before or as soon as possible after applying restraints, with reassessment per policy

CMS requires a physician or licensed independent practitioner order for restraints as soon as possible after application, along with ongoing monitoring and reassessment per facility policy.

Question 104: The synovial membrane lines which aspect of a joint?

The fibrous joint capsule inner surface (Correct answer)
The intervertebral disc
The periosteum of adjacent bones
The articular cartilage surfaces

Correct answer: The fibrous joint capsule inner surface

The synovial membrane lines the inner surface of the fibrous joint capsule and produces synovial fluid for joint lubrication and nutrition.

Question 105: Colchicine is ordered for a patient admitted with acute gout affecting the first metatarsophalangeal joint. The nurse should monitor for which common adverse effect?

Urinary retention and dry mouth
Diarrhea, nausea, and vomiting (Correct answer)
Hyperkalemia and bradycardia
Hypertension and peripheral edema

Correct answer: Diarrhea, nausea, and vomiting

GI toxicity (diarrhea, nausea, vomiting) is the most common dose-limiting adverse effect of colchicine, often signaling the need to reduce or stop the dose.

Question 106: The maximum recommended daily dose of acetaminophen for an adult without liver disease is:

5,000 mg/day
4,000 mg/day (Correct answer)
3,000 mg/day
2,000 mg/day

Correct answer: 4,000 mg/day

The FDA recommends a maximum of 4,000 mg/day of acetaminophen for healthy adults, though many clinicians recommend ≤3,000 mg/day in at-risk populations.

Question 107: When communicating a patient's post-operative status to a surgeon using SBAR, what does the 'R' stand for?

Review
Response
Recommendation (Correct answer)
Report

Correct answer: Recommendation

In SBAR communication, 'R' stands for Recommendation, where the nurse clearly states the action or intervention needed.

Question 108: Subluxation of a joint refers to which condition?

Complete separation of joint surfaces
Inflammation of the joint capsule
Fracture adjacent to a joint
Partial displacement of joint surfaces with some contact remaining (Correct answer)

Correct answer: Partial displacement of joint surfaces with some contact remaining

Subluxation is an incomplete or partial dislocation where joint surfaces are misaligned but maintain some contact, distinguishing it from a full dislocation.

Question 109: A nurse is educating a patient about crutch walking with a non-weight-bearing (NWB) restriction after ankle surgery. Which patient statement indicates a need for further teaching?

'I will keep my elbows slightly bent when using the crutches.'
'I will lift my surgical leg off the floor when walking.'
'I will not bear weight on my surgical leg.'
'I can put a little weight on my heel if I need to steady myself.' (Correct answer)

Correct answer: 'I can put a little weight on my heel if I need to steady myself.'

Non-weight-bearing means no weight at all on the operative limb; placing even heel weight violates the restriction and risks re-injury.

Question 110: The median nerve passes through which anatomical tunnel at the wrist?

Guyon's canal
Cubital tunnel
Tarsal tunnel
Carpal tunnel (Correct answer)

Correct answer: Carpal tunnel

The median nerve travels through the carpal tunnel at the wrist; compression here causes carpal tunnel syndrome.

Question 111: A patient is upset because they were not informed about a change in their surgery time. The nurse's best initial response is to:

Redirect the patient's frustration toward the scheduling department
Explain that scheduling changes are common and unavoidable
Investigate who failed to notify the patient before responding
Apologize for the lapse in communication, provide current accurate information, and address the patient's immediate concerns (Correct answer)

Correct answer: Apologize for the lapse in communication, provide current accurate information, and address the patient's immediate concerns

Acknowledging the failure, apologizing, and correcting the information gap immediately restores trust and addresses the patient's immediate need.

Question 112: A patient 6 weeks post-right total knee replacement reports redness, warmth, swelling, and increased pain at the surgical site. What does the nurse suspect?

Heterotopic ossification
Prosthetic joint infection (Correct answer)
Deep vein thrombosis
Normal postoperative inflammation

Correct answer: Prosthetic joint infection

Persistent or new signs of local inflammation (redness, warmth, swelling, pain) at 6 weeks post-TKR are suspicious for periprosthetic joint infection and require urgent evaluation.

Question 113: A physician orders a corticosteroid injection (triamcinolone) into an arthritic knee joint. Which post-injection instruction should the nurse provide?

Take an antibiotic prophylactically for one week
Ambulate vigorously to distribute the medication
Avoid weight-bearing on the joint for 24–48 hours (Correct answer)
Apply heat immediately to reduce local swelling

Correct answer: Avoid weight-bearing on the joint for 24–48 hours

Resting the injected joint for 24–48 hours allows the corticosteroid to exert its local anti-inflammatory effect without being dispersed by mechanical stress.

Question 114: Which patient characteristic is the STRONGEST independent risk factor for postoperative delirium in orthopaedic patients?

Preexisting cognitive impairment (Correct answer)
Body mass index above 30
History of depression
Female sex

Correct answer: Preexisting cognitive impairment

Preexisting cognitive impairment is the strongest predictor of postoperative delirium in older surgical patients.

Question 115: Which outcome is the primary indicator that a patient is ready for discharge to home after total knee arthroplasty?

Ability to perform self-care and ambulate safely with assistive device (Correct answer)
Radiographic confirmation of bone healing
Full return to pre-surgery range of motion
Complete pain resolution

Correct answer: Ability to perform self-care and ambulate safely with assistive device

Discharge readiness after TKA is determined by the patient's ability to safely ambulate with an assistive device, manage pain, and perform basic activities of daily living.

Question 116: Which finding on a postoperative patient's assessment MOST warrants notification of the surgeon for possible wound complication?

Purulent drainage with erythema extending 2 cm from wound edges on day 5 (Correct answer)
Mild incision site warmth on postoperative day 2
Serosanguineous drainage on postoperative day 1
Ecchymosis surrounding the wound on day 3

Correct answer: Purulent drainage with erythema extending 2 cm from wound edges on day 5

Purulent drainage with spreading erythema is a classic sign of surgical site infection requiring prompt provider notification.

Question 117: A patient with rheumatoid arthritis and a recent orthopaedic procedure is on long-term methotrexate therapy. Which laboratory monitoring is essential before continuing methotrexate?

Serum creatinine and blood urea nitrogen only
Thyroid-stimulating hormone (TSH) and free T4
Serum calcium and phosphorus levels
Complete blood count (CBC) and liver function tests (LFTs) (Correct answer)

Correct answer: Complete blood count (CBC) and liver function tests (LFTs)

Methotrexate is a DMARD that causes bone marrow suppression (CBC) and hepatotoxicity (LFTs); both must be monitored regularly to detect early toxicity and prevent serious complications.

Question 118: What type of traction uses skin tape or foam applied to the skin to exert pulling force on a limb?

Skeletal traction
Manual traction
Skin traction (Correct answer)
Bryant traction

Correct answer: Skin traction

Skin traction applies pulling force through adhesive tapes or foam boots attached to the skin and is suitable for short-term use with lower weight limits.

Question 119: When a nurse identifies a gap between current unit practice and evidence-based guidelines for VTE prophylaxis after joint replacement, the best professional response is to:

Document the concern in the patient's chart only
Implement the new guideline independently without notifying others
Bring the evidence to the attention of the clinical team or quality improvement committee (Correct answer)
Continue current practice to avoid conflict with the team

Correct answer: Bring the evidence to the attention of the clinical team or quality improvement committee

Raising practice concerns through appropriate channels aligns with the professional standard of quality improvement and evidence-based practice.

Question 120: A patient asks the orthopaedic nurse about the risks of their upcoming spinal surgery. The nurse's best response is to:

Explain that only the surgeon can discuss surgical risks and facilitate a timely surgeon conversation (Correct answer)
Provide a printed list of all possible surgical complications
Tell the patient that the surgery is routine and low risk
Fully describe all surgical risks in clinical detail

Correct answer: Explain that only the surgeon can discuss surgical risks and facilitate a timely surgeon conversation

Informed consent regarding surgical risks is the surgeon's legal responsibility; the nurse's role is to facilitate access to that conversation promptly.

Question 121: A patient with a femur fracture develops sudden onset of petechiae, respiratory distress, and confusion 48 hours post-injury. The nurse should suspect:

Anaphylactic reaction to contrast dye
Hypovolemic shock
Fat embolism syndrome (Correct answer)
Pulmonary embolism

Correct answer: Fat embolism syndrome

The classic triad of petechiae, respiratory distress, and neurological changes within 72 hours of long bone fracture indicates fat embolism syndrome.

Question 122: Which structure separates the epiphysis from the diaphysis in growing bone and is the site of longitudinal bone growth?

Physis (growth plate) (Correct answer)
Periosteum
Articular cartilage
Endosteum

Correct answer: Physis (growth plate)

The physis, or growth plate, is the cartilaginous zone between the epiphysis and diaphysis where ossification drives longitudinal bone growth until skeletal maturity.

Question 123: During a shift, a nurse notices that important post-operative instructions were not communicated to the patient by the previous shift. The best action is to:

Provide the missing education now, document what was taught and when, and raise the gap at the next huddle (Correct answer)
Document that the previous nurse failed to provide teaching
Wait for the physician to re-order the teaching
Assume the patient was taught verbally even if undocumented

Correct answer: Provide the missing education now, document what was taught and when, and raise the gap at the next huddle

Immediate provision of missing education protects patient safety, while documentation and reporting the gap at huddle prevents recurrence.

Question 124: The patient's arm is in a sling and a long-arm posterior splint with the elbow in 90-degree flexion following a right total elbow arthroplasty. Which sleeping position is most likely to be cozy for the patient, who needs to keep their right arm raised?

Supine with the head flat
Supine with the head partially elevated (Correct answer)
Side-lying to the left
Side-lying to the right

Correct answer: Supine with the head partially elevated

Following a total elbow arthroplasty, keeping the affected arm elevated is crucial to reduce swelling and promote healing. Sleeping supine (on the back) with the head partially elevated allows for the arm to be comfortably supported and elevated, often with pillows, without putting direct pressure on the surgical site. Side-lying positions would likely put pressure on the splinted arm or make elevation difficult, increasing discomfort and potential complications.

Question 125: What is the benefit of interdisciplinary collaboration in Orthopaedic Nurse Test practice?

It is only for complex projects
It creates confusion
It slows down decision making
It brings diverse expertise and perspectives that improve outcomes and innovation (Correct answer)

Correct answer: It brings diverse expertise and perspectives that improve outcomes and innovation

This is fundamental to Orthopaedic Nurse Test practice. It brings diverse expertise and perspectives that improve outcomes and innovation represents the professional standard for practical in the Orthopaedic Nurse Test certification framework.

Question 126: A patient post-total knee replacement tells the nurse they feel the physiotherapist is 'pushing too hard' and causing pain. The nurse should:

Assess the patient's pain, discuss findings with the physical therapist, and adjust the plan collaboratively (Correct answer)
Advise the patient to refuse therapy if it hurts too much
Tell the patient that post-operative therapy is supposed to be uncomfortable
Report the physical therapist to nursing management

Correct answer: Assess the patient's pain, discuss findings with the physical therapist, and adjust the plan collaboratively

Assessing pain and collaborating with the PT to individualize the therapy plan addresses patient safety while maintaining interdisciplinary respect.

Question 127: A patient with a spinal cord injury at T6 develops sudden severe headache, diaphoresis above the level of injury, and bradycardia. The nurse should FIRST:

Sit the patient upright and identify the noxious stimulus (Correct answer)
Prepare for emergency intubation
Administer IV morphine for pain relief
Place the patient supine to prevent fainting

Correct answer: Sit the patient upright and identify the noxious stimulus

These are signs of autonomic dysreflexia; sitting the patient upright drops blood pressure and the trigger (e.g., full bladder) must be found and removed.

Question 128: A nurse overhears a colleague making a negative comment about a patient's weight in front of other staff. The most appropriate response is to:

Report the colleague to administration without speaking to them first
Address the colleague privately, explain the impact, and report if behavior continues (Correct answer)
Confront the colleague loudly in front of staff to deter future behavior
Ignore it to avoid conflict with the colleague

Correct answer: Address the colleague privately, explain the impact, and report if behavior continues

A private, direct conversation is the first step in addressing unprofessional behavior; escalation through proper channels follows if the behavior continues.

Question 129: Tramadol (Ultram) is prescribed for a patient with moderate orthopaedic pain. The nurse should be aware that tramadol carries a risk of:

Acute angle-closure glaucoma
Severe hepatotoxicity at standard doses
Irreversible bone marrow suppression
Seizures, especially when combined with serotonergic drugs (Correct answer)

Correct answer: Seizures, especially when combined with serotonergic drugs

Tramadol lowers the seizure threshold and inhibits serotonin reuptake; combining it with SSRIs, SNRIs, or other serotonergic agents raises the risk of seizures and serotonin syndrome.

Question 130: In the context of orthopaedic nursing quality assurance, what does a 'process measure' evaluate?

Patient satisfaction scores only
The end result of care such as patient mortality
Staff turnover rates
Whether specific care steps were performed correctly (Correct answer)

Correct answer: Whether specific care steps were performed correctly

Process measures assess whether evidence-based care activities, such as pre-op skin preparation or antibiotic administration timing, are completed correctly.

Question 131: A patient with a language barrier is consenting for a femur fracture repair. Which approach is most appropriate?

Have the surgeon obtain consent without nursing involvement
Use simple English words and gestures to explain the procedure
Use a certified medical interpreter to facilitate the informed consent discussion (Correct answer)
Ask the patient's adult child to translate the consent form

Correct answer: Use a certified medical interpreter to facilitate the informed consent discussion

Certified medical interpreters ensure accurate, unbiased translation of complex medical information, protecting the patient's right to true informed consent.

Question 132: Which law requires orthopaedic hospitals to provide language assistance services to patients with limited English proficiency (LEP)?

The Rehabilitation Act Section 508
EMTALA's stabilization requirement
Americans with Disabilities Act only
Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act (Correct answer)

Correct answer: Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act

Title VI prohibits discrimination based on national origin, and Section 1557 of the ACA requires recipients of federal financial assistance to provide meaningful access, including interpreter services, to LEP patients.

Question 133: A patient with osteoporosis is admitted after a vertebral compression fracture at T12. She rates pain 8/10 and has difficulty ambulating. Which non-pharmacological intervention is the priority?

Implement a fall prevention protocol and assist with log-roll positioning (Correct answer)
Encourage the patient to ambulate independently to prevent deconditioning
Apply heat to the thoracic spine to reduce muscle spasm
Begin range-of-motion exercises to maintain spinal flexibility

Correct answer: Implement a fall prevention protocol and assist with log-roll positioning

Patients with vertebral fractures are at high fall risk, and log-roll technique protects spinal alignment during positioning.

Question 134: Which type of cartilage covers the articulating surfaces of bones in synovial joints?

Fibrocartilage
Yellow cartilage
Hyaline cartilage (Correct answer)
Elastic cartilage

Correct answer: Hyaline cartilage

Hyaline cartilage covers articular surfaces in synovial joints, providing a smooth, low-friction surface for movement.

Question 135: Which bone disease is characterized by low bone mass and microarchitectural deterioration, increasing fracture risk?

Osteomyelitis
Osteoarthritis
Osteoporosis (Correct answer)
Paget's disease

Correct answer: Osteoporosis

Osteoporosis is defined by reduced bone mineral density and deteriorated bone microstructure, leading to fragility fractures with minimal trauma.

Question 136: Which compliance requirement applies when an orthopaedic unit implements a new electronic health record system that stores patient data?

HIPAA Security Rule safeguards for electronic PHI (ePHI) (Correct answer)
The Affordable Care Act's essential health benefits provision
OSHA's Hazard Communication Standard
FDA's 510(k) clearance process

Correct answer: HIPAA Security Rule safeguards for electronic PHI (ePHI)

The HIPAA Security Rule requires covered entities to implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of electronic PHI.

Question 137: A nurse reads a study reporting p < 0.05 for an orthopaedic intervention. This means:

The null hypothesis is rejected at a 5% significance level (Correct answer)
The effect size is large
The study has a 95% power rating
There is a 5% chance the results are clinically significant

Correct answer: The null hypothesis is rejected at a 5% significance level

A p-value < 0.05 means there is less than a 5% probability the results occurred by chance, so the null hypothesis is rejected.

Question 138: A patient's wound VAC dressing over a sternal-sparing hip wound has lost its seal and is no longer creating negative pressure. What should the nurse do first?

Inspect the dressing edges, reinforce with tape or replace the drape, and verify suction resumes (Correct answer)
Remove the wound VAC and apply a standard moist dressing until the wound care team arrives
Document the event and continue monitoring the wound every 4 hours
Increase the negative pressure setting to compensate for the air leak

Correct answer: Inspect the dressing edges, reinforce with tape or replace the drape, and verify suction resumes

A lost wound VAC seal stops therapeutic negative pressure; reinforcing or replacing the drape is the first step to restore function.

Question 139: When a patient's advance directive conflicts with the family's wishes for aggressive post-surgical intervention, the nurse should:

Honor the advance directive, notify the physician and ethics committee if needed, and support the family through the process (Correct answer)
Ask the surgeon to make the final call
Follow the family's wishes to avoid conflict
Defer the decision until the patient regains consciousness

Correct answer: Honor the advance directive, notify the physician and ethics committee if needed, and support the family through the process

Advance directives legally represent the patient's expressed wishes; the nurse must honor them and involve ethics resources when family conflict arises.

Question 140: The rotator cuff of the shoulder is composed of which four muscles?

Deltoid, infraspinatus, teres minor, subscapularis
Deltoid, supraspinatus, infraspinatus, teres major
Supraspinatus, infraspinatus, teres major, subscapularis
Supraspinatus, infraspinatus, teres minor, subscapularis (Correct answer)

Correct answer: Supraspinatus, infraspinatus, teres minor, subscapularis

The rotator cuff consists of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, which stabilize the glenohumeral joint.

Question 141: A hospital case manager requests an update on a patient's post-operative progress. The nurse's best approach is to:

Provide a concise, focused update on functional status, pain control, and discharge readiness (Correct answer)
Refer the case manager directly to the physician
Share the complete medical record for the case manager to review independently
Ask the charge nurse to handle all case manager communications

Correct answer: Provide a concise, focused update on functional status, pain control, and discharge readiness

A concise, relevant clinical update on function, pain, and discharge status enables the case manager to coordinate post-acute care effectively.

Question 142: When delegating cast application teaching to an orthopaedic technician, the nurse remains responsible for:

Supervising the teaching and evaluating the patient's understanding (Correct answer)
Nothing, once the task is delegated
Documenting that the technician completed the teaching
Obtaining physician approval before delegating

Correct answer: Supervising the teaching and evaluating the patient's understanding

Delegation does not transfer the nurse's accountability; the nurse retains responsibility for oversight and verification of patient learning outcomes.

Question 143: A patient with a shoulder arthroplasty reports that the night nurse 'never checked on them.' How should the day nurse respond?

Tell the patient to file a formal complaint
Defend the night nurse and explain that they were likely busy
Dismiss the concern since the chart shows hourly rounding was documented
Acknowledge the patient's experience, assess current needs, and address the concern through appropriate channels (Correct answer)

Correct answer: Acknowledge the patient's experience, assess current needs, and address the concern through appropriate channels

Validating the patient's experience and addressing their immediate needs while using proper channels for follow-up maintains trust and improves care quality.

Question 144: Which exercise is recommended during the early rehabilitation phase following anterior cruciate ligament (ACL) reconstruction?

Full squats to 90 degrees
Closed kinetic chain exercises such as mini-squats (Correct answer)
Plyometric jumping drills
Open kinetic chain leg extensions through full range

Correct answer: Closed kinetic chain exercises such as mini-squats

Closed kinetic chain exercises (e.g., mini-squats, step-ups) are preferred in early ACL rehab as they promote co-contraction of stabilizing muscles with less graft stress.

Question 145: A patient's adult children disagree with each other about whether their parent should have surgery for a hip fracture. The patient is cognitively intact. What is the priority?

Clarify the patient's own informed decision, since a competent patient has autonomy (Correct answer)
Ask the surgeon to make the final decision
Defer to the eldest child as next of kin
Hold a family meeting and let the family decide

Correct answer: Clarify the patient's own informed decision, since a competent patient has autonomy

A cognitively intact adult patient has the legal and ethical right to make their own healthcare decisions regardless of family disagreement.

Question 146: How should an Orthopaedic Nurse Test professional approach a novel situation not covered by standard procedures?

Refuse to proceed
Follow the closest standard procedure exactly
Apply foundational principles, assess risks, consult resources, and document the rationale for decisions (Correct answer)
Improvise without documentation

Correct answer: Apply foundational principles, assess risks, consult resources, and document the rationale for decisions

This is fundamental to Orthopaedic Nurse Test practice. Apply foundational principles, assess risks, consult resources, and document the rationale for decisions represents the professional standard for practical in the Orthopaedic Nurse Test certification framework.

Question 147: An orthopaedic nurse is preparing to communicate a critical lab value (low hemoglobin post-operatively) to the on-call physician by phone. Which approach is safest?

Text the value to the physician and document it was sent
Use SBAR, read back orders received, and document the call with time, recipient, and response (Correct answer)
Ask the charge nurse to make the call
Leave a voicemail with the lab value and await callback

Correct answer: Use SBAR, read back orders received, and document the call with time, recipient, and response

Structured SBAR communication with read-back verification and documentation is the standard for safe critical value communication.

Question 148: What is the primary goal of continuous passive motion (CPM) machine use after total knee replacement?

Prevent infection at the surgical site
Maintain and improve joint range of motion (Correct answer)
Reduce postoperative bleeding
Stimulate bone growth around the prosthesis

Correct answer: Maintain and improve joint range of motion

CPM machines passively flex and extend the knee joint postoperatively to prevent stiffness, reduce scar tissue formation, and promote cartilage nutrition.

Question 149: Which anatomical landmark is used to identify the greater trochanter of the femur during assessment?

Posterior superior iliac spine
Bony prominence felt on the lateral proximal thigh (Correct answer)
Ischial tuberosity
Bony prominence felt on the medial knee

Correct answer: Bony prominence felt on the lateral proximal thigh

The greater trochanter is palpated as a bony prominence on the lateral aspect of the proximal femur and serves as a landmark for hip assessment.

Question 150: Which kind of metastasis should be carefully watched for in a patient with osteosarcoma of the proximal end of the humerus?

Kidney
Lung (Correct answer)
Liver
Brain

Correct answer: Lung

Osteosarcoma is a highly aggressive bone cancer with a strong tendency to metastasize hematogenously (via the bloodstream). The lungs are the most common site for distant metastasis, occurring in a significant percentage of patients. Therefore, careful monitoring for lung metastases is crucial for staging, treatment planning, and determining the prognosis in individuals with osteosarcoma.

Question 151: A kid with achondroplasia experiences numbness, sleep apnea, widespread weakness, urine and fecal incontinence, and rapid reflexes. Which of the following complications needs to be evaluated at the beginning for the child?

Cervicomedullary compression (Correct answer)
Spinal cord myelopathy
Chronic otitis media
Hydrocephalus

Correct answer: Cervicomedullary compression

Achondroplasia often leads to a narrowed foramen magnum, the opening at the base of the skull. This narrowing can cause compression of the cervicomedullary junction, where the brainstem meets the spinal cord. The described symptoms (numbness, sleep apnea, weakness, incontinence, rapid reflexes) are classic signs of neurological compression at this critical area, requiring urgent evaluation to prevent severe neurological damage.

Orthopaedic Nurse Certified (ONC) Exam

The ONC exam, administered by the Orthopaedic Nurses Certification Board (ONCB), validates a registered nurse's specialized knowledge in orthopaedic care including musculoskeletal conditions, surgical procedures, pain management, and patient rehabilitation.

150

Questions

180 min

Time Limit

72%

To Pass

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