Orthopaedic Nurse Certified (ONC) Exam — Questions and Answers

Question 1: Which type of bone fracture in children occurs on one cortex only, with the other side bending but not breaking?

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

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

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

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

Humerus
Tibia
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 4: Contraindications to ultrasound therapy include

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

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 5: A nurse identifies that a patient with a long leg cast is experiencing compartment syndrome. Advocating for immediate intervention reflects which ethical principle?

Non-maleficence (Correct answer)
Autonomy
Fidelity
Justice

Correct answer: Non-maleficence

Non-maleficence—doing no harm—obligates the nurse to prevent avoidable injury by acting swiftly when compartment syndrome is suspected.

Question 6: A tourniquet is applied during extremity surgery primarily to achieve which goal?

Provide a bloodless surgical field (Correct answer)
Prevent DVT formation
Stabilize the limb
Reduce postoperative swelling

Correct answer: Provide a bloodless surgical field

Pneumatic tourniquets are applied proximal to the surgical site to occlude arterial flow and create a bloodless field, improving surgical visualization.

Question 7: An orthopaedic nurse who preceptors new staff is functioning in which professional role?

Educator (Correct answer)
Case manager
Researcher
Administrator

Correct answer: Educator

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

Question 8: Which complication is MOST closely associated with tourniquet use during orthopaedic limb surgery?

Arterial thrombosis only
Venous air embolism
Compartment syndrome and nerve injury (Correct answer)
Fat embolism syndrome

Correct answer: Compartment syndrome and nerve injury

Prolonged tourniquet use can cause compartment syndrome and pressure-related nerve injury distal to the cuff.

Question 9: Heterotopic ossification following total hip replacement is best detected by which diagnostic method?

MRI of the hip
Bone biopsy
CT angiogram
Plain X-ray of the pelvis (Correct answer)

Correct answer: Plain X-ray of the pelvis

Heterotopic ossification (abnormal bone formation in soft tissue around the hip) is detected on plain radiographs and graded using the Brooker classification.

Question 10: Which technology is commonly used in the operating room to provide real-time intraoperative imaging guidance during orthopaedic procedures such as spinal fusion?

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

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 11: How should an Orthopaedic Nurse Test professional present complex information to non-experts?

Skip complex topics entirely
Use full technical terminology
Provide written reports only
Translate into accessible language, use visuals, and check for understanding (Correct answer)

Correct answer: Translate into accessible language, use visuals, and check for understanding

This is fundamental to Orthopaedic Nurse Test practice. Translate into accessible language, use visuals, and check for understanding represents the professional standard for communication in the Orthopaedic Nurse Test certification framework.

Question 12: Which anticoagulation agent is most commonly used for DVT prophylaxis following total knee replacement in the US?

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

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

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

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 14: A patient scheduled for knee arthroplasty is visibly anxious and asks repetitive questions about the surgery. The nurse's most therapeutic response is to:

Document the anxiety and request a sedative order
Limit responses to avoid reinforcing anxiety
Respond calmly to each question, identify the source of anxiety, and offer pre-operative education tools (Correct answer)
Encourage the patient to wait and ask the surgeon in the OR

Correct answer: Respond calmly to each question, identify the source of anxiety, and offer pre-operative education tools

Calm, consistent responses and targeted education address the cognitive and emotional components of pre-operative anxiety effectively.

Question 15: When preparing a surgical site for orthopaedic surgery, what is the recommended skin antiseptic agent per current evidence-based guidelines?

Chlorhexidine-alcohol solution (Correct answer)
Povidone-iodine scrub only
Hydrogen peroxide
Saline irrigation

Correct answer: Chlorhexidine-alcohol solution

Chlorhexidine-alcohol is the preferred preoperative skin antiseptic per CDC surgical site infection prevention guidelines due to its superior persistent antimicrobial activity.

Question 16: How should Orthopaedic Nurse Test professionals handle conflicts with stakeholders?

Avoid all conflict
Address issues professionally through active listening, finding common ground, and seeking resolution (Correct answer)
Escalate immediately to management
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 17: A nurse notices a colleague documenting care that was not performed. The most appropriate action is to:

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

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 18: The menisci of the knee serve which primary function?

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

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 19: Which patient is at HIGHEST risk for intraoperative and postoperative hemorrhage during orthopaedic surgery?

A patient with a history of von Willebrand disease (Correct answer)
A patient on metformin for type 2 diabetes
A patient taking aspirin stopped 5 days ago
A patient with controlled hypertension

Correct answer: A patient with a history of von Willebrand disease

Von Willebrand disease impairs platelet adhesion and clotting factor VIII activity, significantly increasing bleeding risk.

Question 20: A nurse reports that the orthopaedic unit's clinical pathway for hip replacement is not being consistently followed. Which approach BEST addresses this gap?

Audit adherence, identify barriers, and engage staff in revising the pathway (Correct answer)
Remove the clinical pathway and rely on physician preference
File a complaint against non-compliant physicians
Wait for the annual quality review to address the issue

Correct answer: Audit adherence, identify barriers, and engage staff in revising the pathway

Auditing compliance, identifying barriers, and involving frontline staff in solutions leads to sustainable improvement in pathway adherence.

Question 21: What role does active listening play in Orthopaedic Nurse Test practice?

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

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 22: Fat embolism syndrome (FES) following long bone fracture most commonly presents with which classic triad?

Dyspnea, hemoptysis, and pleuritic chest pain
Hypoxia, neurological changes, and petechial rash (Correct answer)
Fever, jaundice, and hemoptysis
Bradycardia, hypertension, and cyanosis

Correct answer: Hypoxia, neurological changes, and petechial rash

The classic fat embolism syndrome triad includes hypoxemia, neurological dysfunction (confusion), and petechial rash on the chest, axillae, and conjunctivae.

Question 23: Which ligament of the knee prevents anterior displacement of the tibia on the femur?

Lateral collateral ligament
Anterior cruciate ligament (Correct answer)
Medial collateral ligament
Posterior cruciate 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 24: Subluxation of a joint refers to which condition?

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

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 25: Which best describes the difference between a nursing diagnosis and a medical diagnosis?

Medical diagnoses focus on patient coping; nursing diagnoses focus on pathology
Nursing diagnoses are made only by advanced practice nurses
A nursing diagnosis requires a physician's order to document
Nursing diagnoses identify human responses to health conditions; medical diagnoses identify disease processes (Correct answer)

Correct answer: Nursing diagnoses identify human responses to health conditions; medical diagnoses identify disease processes

Nursing diagnoses (e.g., Impaired Physical Mobility) describe patient responses to illness, while medical diagnoses (e.g., femoral fracture) identify pathological conditions.

Question 26: Which complication is specifically associated with prolonged use of a tight plaster cast on a limb?

Fat embolism
Compartment syndrome (Correct answer)
Avascular necrosis
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 27: The neurovascular assessment '5 Ps' for a casted extremity includes pain, pallor, pulselessness, paresthesia, and which fifth component?

Paralysis (Correct answer)
Petechiae
Perspiration
Pressure

Correct answer: Paralysis

The 5 Ps of neurovascular assessment are Pain, Pallor, Pulselessness, Paresthesia, and Paralysis, guiding early detection of vascular compromise or compartment syndrome.

Question 28: What is the primary purpose of regulatory compliance in Orthopaedic Nurse Test practice?

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

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

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

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

Osteomyelitis
Osteoporosis (Correct answer)
Osteoarthritis
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.

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.

Questions

35 min

Time Limit

72%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds