ONC General Practice Exam 50 Questions with Verified Answers
To establish the diagnosis of osteoporosis, a patient's primary care provider orders a
... [Show More] DEXA scan (dual energy x-ray absorptiometry). The patient asks the nurse, "How will the test show if I have osteoporosis?" The nurse's response should be based on knowledge that which of the following accurately describes this procedure?
a. The patient will be given a radioactive isotope several hours before the scan, and its uptake into the patient's bones will be measured.
b. The patient's bone density will be compared to the reference range of healthy young adults.
c. The amount of calcium in the patient's bones will be compared to the patient's serum values of osteocalcin and alkaline phosphatase.
d. The patient's peak bone mass will be measured by comparing the ratio of cortical to cancellous bone in her distal forearm. - CORRECT ANSWER b. The patient's bone density will be compared to the reference range of healthy young adults.
Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean young adult normal reference range (known as the T-score). DEXA is a noninvasive diagnostic that does not require the use of a radioisotope. There are also no associated laboratory studies, and assessment of the distal forearm is not completed as part of DEXA scanning.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96
A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is prescribed. The nurse should give which of these instructions about the drug to the patient?
a. "Take the Actonel at night immediately before you got to bed."
b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption of the Actonel."
c. "After taking Actonel, remain in an upright position for at least 30 minutes."
d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." - CORRECT ANSWER c. "After taking Actonel, remain in an upright position for at least 30 minutes."
Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at least 30 minutes before breakfast, and the patient should remain in an upright position.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1
A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient understands this disease is caused by inadequate intake of vitamin D, but asks the nurse what other factors may have contributed to development of this condition. Based on the patient's history, the nurse should identify which of the following as a risk factor for decreased synthesis of vitamin D?
a. Having renal disease
b. Having light skin
c. Living at low altitude
d. Living on a farm - CORRECT ANSWER a. Having renal disease
Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased bone mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as fair skin. Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at lower altitudes. Living on a farm has no direct impact, but living in long-term care facilities with limited exposure to sunlight can affect vitamin D synthesis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383
The mother of a 50-year-old patient has been diagnosed with osteoporosis. The patient asks about her own risk for the disease. Based on discussion with the patient about her history and lifestyle, the nurse should identify which of the following as a risk factor for osteoporosis?
a. She is 10 pounds overweight.
b. She smokes one pack of cigarettes per day.
c. She drinks two cups of coffee every morning.
d. She never had children. - CORRECT ANSWER b. She smokes one pack of cigarettes per day.
Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset of menopause and the lowering of bone mineral density. Being overweight does not contribute to osteoporosis; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor. Never having had children is only a factor if it contributes to early menopause.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379
A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands, feet, and knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and encourages evaluation by a healthcare provider. What other, early symptom should lead the nurse to suspect RA?
a. Hip pain
b. Photosensitivity
c. Weight gain
d. Fatigue - CORRECT ANSWER d. Fatigue
Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341
After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness, a patient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are likely to include which of the following?
a. Erythrocyte sedimentation rate 20 mm/hr
b. Rheumatoid factor 12 IU/ml
c. Serum uric acid 7.6 mg/dL
d. White blood cell count 7000 cells/microliter - CORRECT ANSWER c. Serum uric acid 7.6 mg/dL
Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis because of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute inflammation, a value of 20 mm/hr is normal (0-22 for men, 0-29 for women). Less than 14 IU/ml is considered a normal RF value, as is 7000 white cells/microliter (normal 4000-11,000).
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363
A patient with newly diagnosed rheumatoid arthritis is prescribed diclofenac (Voltaren®) and methotrexate. The nurse should understand these two medications are prescribed together primarily to
a. maximize the patient's activity level.
b. minimize steroidal side effects.
c. minimize the patient's immune response.
d. maximize control of inflammation. - CORRECT ANSWER d. maximize control of inflammation.
Rationale: NSAIDs are used to improve joint function by decreasing acute inflammation and pain. However, they cannot alter the course of RA or prevent joint damage. Thus they are prescribed for use while the patient awaits therapeutic effects of a DMARD such as methotrexate or a biologic response modifier.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 342-344
A patient newly diagnosed with ankylosing spondylitis receives a prescription for etanercept (Enbrel®). Which of the following statements should the nurse include in patient teaching on this medication?
a. "This medication will be given once a week for your condition."
b. "This medication can cause GI upset and mild diarrhea."
c. "Be sure to use birth control while taking this Enbrel."
d. "Schedule an eye exam every year while taking Enbrel because of the risk of corneal damage." - CORRECT ANSWER a. "This medication will be given once a week for your condition."
Rationale: Enbrel is typically prescribed for subcutaneous injection every week, with the initial dose of 50 mg for ankylosing spondylitis. This biologic response modifier is not likely to cause GI upset and diarrhea; these problems are more likely with DMARDs. Birth control is recommended during use of the DMARD leflunamide (Arava®) because of its teratogenic effects. Corneal damage is possible with the DMARD hydrochloroquine (Plaquenil®), but it is not related to use of Enbrel.
Reference: Drugs.com. (n.d.) Enbrel Dosage. Retrieved from https://www.drugs.com/dosage/enbrel.html
A patient with long-standing RA develops flexion of the proximal interphalangeal (PIP) joints and hyperextension of the distal interphalangeal (DIP) joints on the third and fourth fingers of her right hand. The nurse should recognize these changes as characteristic of
a. swan-neck deformities.
b. boutonniere deformities.
c. Bouchard's nodes.
d. Heberden's nodes. - CORRECT ANSWER b. boutonniere deformities.
Rationale: A boutonniere deformity occurs due to rupture of the extensor tendon mechanism of the finger over the proximal interphalangeal (PIP) joint. This causes hyperextension of the distal interphalangeal (DIP) joint). In a swan-neck deformity, the PIP is in hyperextension and the DIP in flexion. Bouchard's and Heberden's nodes are associated with osteoarthritis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 530
A patient who underwent total knee arthroplasty for rheumatoid arthritis is prescribed rivaroxaban (Xarelto®) for VTE prophylaxis. The patient tells the nurse, "I was prescribed Coumadin for my last surgery. Why am I receiving a different medication?" The nurse's response should be based on the knowledge that Xarelto
a. has a longer half-life.
b. has a specific reversal agent.
c. does not affect prothrombin time.
d. does not increase bleeding risk. - CORRECT ANSWER c. does not affect prothrombin time.
Rationale: The factor Xa medications such as rivaroxaban do not have notable effects on prothrombin time and thus do not require serial INR monitoring. These drugs also do not have specific reversal agents. They do have shorter half-lives than Coumadin. All anticoagulant medications can increase bleeding risk.
Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 140
A 12-year-old patient experiences an epicondylar fracture in a softball game and a long-arm cast is applied. If the cast needs to be split after application to allow for tissue swelling, the nurse will bivalve the cast by splitting it
a. anteriorly and medially.
b. posteriorly and laterally.
c. anteriorly and posteriorly.
d. medially and laterally. - CORRECT ANSWER d. medially and laterally.
Rationale: A bivalved cast is split medially and laterally to create anterior and posterior portions.
Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 30
A patient with a hip fracture is placed in 5 pounds of Buck's traction and surgery is scheduled for the next morning. The nurse should know the Buck's traction is used to
a. minimize muscle spasm.
b. increase blood flow to fracture fragments.
c. decrease the risk of thrombosis.
d. maximize the patient's bed mobility. - CORRECT ANSWER a. minimize muscle spasm.
Rationale: Buck's traction is used for immobilization of unrepaired hip fractures, with some relief of muscle spasms.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 254, 551
A patient is out of bed and ambulating late on the day of surgery following total knee arthroplasty. The nurse should recognize that early ambulation
a. prevents drainage from the incision.
b. decreases the risk of clot formation.
c. decreases the need for physical therapy.
d. reverse the effects of anesthesia. - CORRECT ANSWER b. decreases the risk of clot formation.
Rationale: Prophylaxis to decrease the risk of VTE is universally recommended. Commonly used strategies are often multimodal and include a combination of medications, mechanical compression, and early mobilization. Other options are not effects of early ambulation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 578
Following application of a short-arm cast on a patient with a buckle fracture of the wrist, the nurse will assess sensation and motion in the patient's digits. The nurse should recognize numbness and tingling between the thumb and index finger may indicate compromise of which nerve?
a. Peroneal
b. Ulnar
c. Radial
d. Median - CORRECT ANSWER c. Radial
Rationale: The radial nerve gives sensation to the dorsum of the hand from the thumb to the third finger.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 20
A patient arrives on the surgical unit following spinal fusion. The nurse should institute spine precautions that require
a. logrolling for bed mobility.
b. forward-bending exercises to strengthen the spine.
c. sitting for frequent periods in a recliner.
d. rotational exercises to increase spine flexibility. - CORRECT ANSWER a. logrolling for bed mobility.
Rationale: Logrolling provides uniform support for the back as the patient is turned from side to side. Other activities cause spinal rotation that can disrupt the surgical site in the spine.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 456
A patient is receiving mitoxantrone (Novantrone®) for treatment of an exacerbation of multiple sclerosis. In administering the drug, the nurse should be aware that
a. there is a lifetime dose limit due to its renal toxicity.
b. the patient may experience permanent hair loss.
c. the patient's urine may turn a blue-green color initially.
d. it should be stored in the unit medication refrigerator. - CORRECT ANSWER c. the patient's urine may turn a blue-green color initially.
Rationale: The nurse should know the patient's urine may turn a blue-green color for a few days following each dose of mitoxantrone. The patient's sclera also may have a slight blue color. This information should be provided to the patient and family.
Reference: National Multiple Sclerosis Society. (n.d.). Novantrone. Retrieved from https://www.nationalmssociety.org/Treating-MS/Medications/Novantrone (See Novantrone Medication Guide for Patients)
A patient is diagnosed with osteoid osteoma. The nurse should be able to confirm this is a benign tumor that
a. requires wide excision in 90% of affected patients.
b. causes night pain that can be relieved by aspirin.
c. usually develops into a large osteoblastic lesion.
d. occurs most often in the spine and femur. - CORRECT ANSWER b. causes night pain that can be relieved by aspirin.
Rationale: As a primary benign tumor, osteoid osteoma is characterized by night pain often relieved by aspirin or NSAIDs.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 425
While discussing the treatment plan for an adolescent with a malignancy of the distal femur, the nurse should explain to the family that the most common malignant bone tumor in children and adolescents is
a. osteoblastoma.
b. chondrosarcoma.
c. osteosarcoma.
d. osteochondroma - CORRECT ANSWER c. osteosarcoma.
Rationale: Osteosarcoma is the most common primary malignant bone tumor in children, with occurrence greater in boys than girls.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 430
A patient is diagnosed with slipped capital femoral epiphysis (SCFE). The nurse should recognize the patient is at higher than normal risk of developing
a. progressive deformity.
b. severe growth failure.
c. joint contracture.
d. secondary osteoarthritis. - CORRECT ANSWER d. secondary osteoarthritis.
Rationale: The patient with SCFE is at risk for developing secondary osteoarthritis related to chondrolysis, AVN, or deformity from SCFE. The other conditions are not considerations with SCFE.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 314
A 12-year-old cross-country runner has been diagnosed with Osgood-Schlatter disease. While reviewing the overall treatment plan with the patient and family, the nurse should include information about which of the following?
a. Symptoms will stop by the end of skeletal growth.
b. Long-term damage to the knee can result if inflammation persists.
c. Pain may be relieved by flexion exercises.
d. Surgery will offer the best hope of symptom relief. - CORRECT ANSWER a. Symptoms will stop by the end of skeletal growth.
Rationale: Osgood-Schlatter disease is a self-limiting condition of pre-adolescence; symptoms stop when apophysis is fully ossified.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 302
The nurse is providing pre-operative teaching to a patient scheduled for an open reduction-internal fixation (ORIF) of the femur. Which of the following biologic implants should the nurse recognize is used to fill in bony defects?
a. Cannulated screw
b. Cortical strut
c. Polypropylene cup
d. Compression plate - CORRECT ANSWER b. Cortical strut
Rationale: Biologic implants include bone and allograft tissue such as a cortical strut. The other options are not biologic implants.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 134; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92
While caring for a patient undergoing a shoulder arthroscopy, the nurse assists with positioning the patient in a lateral decubitus position. Which of the following nerves should the nurse recognize may sustain injury when the patient is placed in the lateral position and there is inadequate padding under the fibular head?
a. Saphenous
b. Tibial
c. Sural
d. Peroneal - CORRECT ANSWER d. Peroneal
Rationale: Peroneal nerve damage is caused by compression over the lateral aspect of the fibular head or from prolonged plantar flexion of the foot. The saphenous nerve runs superficially at the medial thigh and may be impaired by direct compression from a tourniquet or arthroscopic leg holder. The tibial nerve diverges at the popliteal fossa and travels down the leg to the medial aspect of the ankle. The sural nerve is found laterally at the ankle and foot.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 129; Orthopaedic Surgery Manual (3rd ed.), 2017, p. 50
Two days before scheduled total hip arthroplasty, a patient comes to the surgeon's office for the final preoperative assessment. Which of the following statements by the patient should require further investigation by the nurse?
a. "It's hard for me to get moving in the morning because I'm so stiff."
b. "Every evening I drink a glass of wine."
c. "I had a nasty tooth pulled last week."
d. "The arthritis in my feet has been giving me trouble this week." - CORRECT ANSWER c. "I had a nasty tooth pulled last week."
Rationale: Acute infection may be a contraindication for THA due to increased risk of bacteria infecting the replaced hip.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 553
The patient undergoes right total hip arthroplasty with a posterolateral approach. Following a short stay in the post-anesthesia unit, the patient is transferred to the orthopaedic surgical unit. Which of these observations made by the nurse should indicate the positioning of the patient's right extremity is correct?
a. Leg is in adducted position.
b. Hip is flexed 90 degrees.
c. Leg is in neutral position.
d. Hip is internally rotated. - CORRECT ANSWER c. Leg is in neutral position.
Rationale: Following THA with a posterolateral approach, the patient should not flex the hip beyond 90 degrees, cross the operative leg past the body's midline (adduction), or internally rotate the surgical hip. The leg should be maintained in neutral position.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 556
A patient who had total knee arthroplasty two days ago is now suspected of having deep vein thrombosis. The nurse should identify a positive Homan's sign if
a. the knee is pressed against the bed and the leg is extended.
b. the foot is dorsiflexed and the leg is extended.
c. a tourniquet is applied below the knee and the leg is flexed 90 degrees.
d. the foot is laterally rotated and the leg is flexed 90 degrees. - CORRECT ANSWER b. the foot is dorsiflexed and the leg is extended.
Rationale: Homan's sign is marked by discomfort in the upper calf with forced dorsiflexion of the foot. Although often assessed, it is not specific to or sensitive for deep vein thrombosis.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 61
A nursing assistant reports to the nurse that a patient who had total shoulder arthroplasty is complaining of pain. The nurse takes all of the following actions. Which action should the nurse take FIRST?
a. Administer the medication prescribed for breakthrough pain.
b. Determine if the PCA pump is working properly.
c. Examine the patient's operative site.
d. Assess the patient's pain. - CORRECT ANSWER d. Assess the patient's pain.
Rationale: Research has shown that the most common reason for unrelieved pain is the failure of staff to routinely assess pain. Pain must be assessed before it can be treated.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p.166
A 10-year-old child was skiing with family members. After experiencing a forward fall, the child immediately complained of lower leg pain and was taken to the nearest emergency department. X-rays confirmed a nondisplaced fracture of the tibial shaft. The nurse should expect the child to receive which of the following treatments?
a. Long-leg cast
b. Open reduction, internal fixation
c. Percutaneous pinning
d. Adduction bracing - CORRECT ANSWER a. Long-leg cast
Rationale: Non-displaced tibial shaft fractures in children may be immobilized conservatively by using a long-leg cast. A short-leg cast also may be used. Other options are not appropriate for tibial shaft fractures in childhood.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 408, Table 15-9
Following surgical fixation of a distal femur fracture, a patient is receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse should know that compared to traditional pain management strategies, PCA has the advantage of
a. allowing quick titration of the analgesia.
b. providing a safe route for meperidine (Demerol®) administration.
c. reducing the need for nurse assessment.
d. delivering medication safely for opioid-naïve patients. - CORRECT ANSWER a. allowing quick titration of the analgesia.
Rationale: Advantages to the PCA include the ability to titrate the drug quickly, maintenance of analgesic serum concentration with supplemental continuous infusion, predictable absorption rate, and patient control. Assessment and reassessment are keys to the effective, safe use of PCA, and should be completed in accordance with hospital policy. Meperidine use is not recommended in PCA because of effects of the metabolic normeperidine. PCA is not recommended for opioid-naïve patients.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 172
Following traumatic injury, a patient is diagnosed with fat embolism syndrome (FES). The nurse should recognize risk factors for FES include which of the following?
a. Older age
b. Long bone fracture
c. Previous fracture
d. Smoking - CORRECT ANSWER b. Long bone fracture
Rationale: Long bone fractures are a risk factor in approximately 90% of cases of FES. The other options are not risk factors for FES.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 203
A 24-year-old female underwent surgery for multiple fractures caused by a motor vehicle crash. A week into her recovery, she is diagnosed with deep vein thrombosis in the left calf. The patient's spouse asks, "How could this happen?" In answering this question, with of the following in the patient's lifestyle and history should the nurse identify as increasing the risk for DVT?
a. Patient age
b. Body mass index 23.6
c. History of iron deficiency
d. Contraceptive use - CORRECT ANSWER d. Contraceptive use
Rationale: Use of estrogen (e.g., contraceptives, estrogen replacement therapy) increases a person's risk for DVT. Obesity (BMI 30 or higher; BMS 25-29.9 is overweight) and age over 40 are also risk factors. History of iron deficiency is not a factor in the development of DVT
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 201
A computer programmer complains of numbness, tingling, and burning pain in the thumb, index, and long fingers of the dominant right hand. The symptoms have lasted 3 months and awaken the patient several times each night. The diagnosis of carpal tunnel syndrome (CTS) is made. The nurse should assess the patient to determine if she also has symptoms in which of these areas commonly affected in CTS?
a. Radial styloid process
b. Ulnar styloid process
c. Radial side of the ring finger
d. Ulnar side of the little finger - CORRECT ANSWER c. Radial side of the ring finger
Rationale: The radial side of the ring finger is enervated by the median nerve. Paresthesia over the sensory distribution of the medial nerve is the most frequent symptom of CTS.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 546
A patient comes to the clinic with complaint of the left index finger locking in a flexed position. The patient states, "I often hear a popping sound when I try to bend or straighten my finger." The patient's history includes type 2 diabetes, hypertension, and hypercholesterolemia. X-rays rule out bony pathology and the patient is diagnosed with trigger thumb. Which of the following should the nurse include in educating this patient about trigger finger?
a. "Apply moist heat for 20 minutes every 6-8 hours to reduce pain and swelling."
b. "Try to keep fasting blood glucose results below 100 mg/dL."
c. "Your provider has ordered physical therapy to decrease inflammation."
d. "The steroid injection you received can be repeated every 3 months." - CORRECT ANSWER b. "Try to keep fasting blood glucose results below 100 mg/dL."
Rationale: Patients with diabetes have a fourfold increased chance of developing trigger finger; they should make every effort to maintain normal blood glucose. Ice may be applied for 20 minutes at a time every 4-6 hours to reduce pain and swelling. Physical therapy may used to increase ROM, but the mechanics of trigger finger will not be affected unless steroid patches are used through iontophoresis. Corticosteroid injections are not usually successful in patients with diabetes; however, injections are usually limited to two lifetime injections in the triggering area.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 539
A patient presents to the clinic with complaints of numbness, tingling, and burning pain in the thumb, index finger, and middle finger of the right hand. The nurse tells the patient Phalen's test will be performed to help determine the presence of carpal tunnel syndrome (CTS). This nurse should FIRST
a. ask the patient to flex both wrists.
b. ask the patient to extend both wrists.
c. tap lightly over the volar surface of the patient's wrists.
d. tap lightly over the dorsal surface of the patient's wrists. - CORRECT ANSWER a. ask the patient to flex both wrists.
Rationale: The nurse should ask the patient to flex the both wrists and push the dorsal surfaces together for at least 1 minute. If the maneuver causes tingling in the distribution of the median nerve, CTS is considered probable.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 53
A patient comes to the clinic with complaint of increasing left leg pain. The patient denies any known injury. After physical assessment and x-rays, the patient is diagnosed with degenerative disc disease. Which of the following instructions should the nurse provide as part of conservative treatment?
a. "Sit as often as possible to rest your back."
b. "Limit the addition of salt to your meals."
c. "Avoid use of tobacco products."
d. "Modify your activities within comfort levels." - CORRECT ANSWER d. "Modify your activities within comfort levels."
Rationale: Patients with DDD are encouraged to modify their activities within comfort levels to avoid acute exacerbations and to allow acute symptoms to resolve. Sitting will not help in resolution of the symptoms; sitting more than 30 minutes may actually result in worse pain. Limited use of salt or tobacco products would have not impact.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 461
A patient with herniated nucleus pulposus underwent lumbar fusion and discectomy after repeated attempts at conservative treatment had been ineffective. In preparing for discharge, the patient asks why additional physical therapy is needed. The nurse's response should be based on the knowledge that physical therapy after this procedure would be particularly beneficial for
a. improving disc height.
b. increasing muscle mass.
c. stabilizing the trunk.
d. maintaining balance. - CORRECT ANSWER c. stabilizing the trunk.
Rationale: PT should be encouraged after this type of surgery, with the primary goal of trunk stabilization to prevent recurrence of disc herniation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 460
A newborn boy has been diagnosed with developmental dysplasia of the hip (DDH). When counseling the family in the clinic, which of these factors in the infant's history should the nurse explain to the parents may be associated with DDH?
a. Breech birth
b. Male gender
c. African-American ethnicity
d. Low birth weight - CORRECT ANSWER a. Breech birth
Rationale: About 30%-50% of children with DDH have a history of breech presentation. The other factors are not associated with DDH.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 280
The nurse is evaluating a young child in the clinic for Type l osteogenesis imperfecta. The child presents with a history of blue sclera and a number of fractures when starting to walk. Which of the following should the nurse understand about this disorder when counseling the family?
a. Patients with Type l osteogenesis imperfecta do not have a normal life expectancy.
b. Fractures will increase after puberty in Type l osteogenesis imperfecta.
c. Type l osteogenesis imperfecta is an autosomal dominant condition.
d. Pulmonary insufficiency is often seen in patients with Type I osteogenesis imperfecta. - CORRECT ANSWER c. Type l osteogenesis imperfecta is an autosomal dominant condition.
Rationale: Type 1 osteogenesis imperfecta is autosomal dominant and patients with the disorder have a normal life expectancy. It is the mildest form of OI and fractures will decrease after puberty.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 304-305
When screening a child for scoliosis, the school nurse identifies multiple cafe-au-lait spots and freckling in the axillae and skin folds. The nurse should recommend a follow-up assessment by a pediatric orthopedist to evaluate the child for which of the following?
a. Muscular dystrophy
b. Neurofibromatosis
c. Myelodysplasia
d. Osteogenesis imperfecta - CORRECT ANSWER b. Neurofibromatosis
Rationale: Cafe-au-lait spots and freckling in the skin folds are classic cutaneous manifestations of neurofibromatosis. They are not seen in the other disease processes.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 299-300
The nurse is providing education to the family of a newborn with bilateral clubfeet. Which of the following casting methods should the nurse identify as used for the treatment of talipes equinovarus?
a. Mehta casting
b. Ponseti casting
c. Risser casting
d. Spica casting - CORRECT ANSWER b. Ponseti casting
Rationale: Ponseti serial casting is the standard for clubfoot casting. Mehta and Risser casts are torso casts used for spinal deformity. A spica is usually a hip or shoulder cast.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 279
A 19-year-old football player at a local college sustains an acute left anterior shoulder dislocation when he attempts to block a high pass during a football game. After initial evaluation by the team physician, the patient is transferred to the local hospital's emergency department. The nurse who first assesses the patient should be aware that the shoulder is the most easily dislocated joint because of the relatively weak articulation of the
a. acromioclavicular joint.
b. scapulothoracic juncture.
c. sternoclavicular juncture.
d. glenohumeral joint. - CORRECT ANSWER d. glenohumeral joint.
Rationale: Dislocation of the glenohumeral joint accounts for 50% of all major joint dislocations. This joint allows greater range of motion than other ball-and-socket joints but has less stability.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 476
A football player leaves the game in pain after a hard tackle. He is taken to the emergency department (ED) and diagnosed with posterior sternoclavicular separation. With this type of injury, the nurse in the ED should know it is critical to frequently assess the patient's
a. circulation.
b. sensation.
c. respirations.
d. range of motion. - CORRECT ANSWER c. respirations.
Rationale: SC joint separations can result in lethal complications from a pneumothorax. The nurse must monitor the patient's breathing.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 499
A basketball player with a grade II lateral ankle sprain is placed in a CAM boot after being seen in the Urgent Care Center. The patient asks the nurse if weight can be placed on the ankle. The nurse's response should be based on knowledge of which of the following provider orders for this patient?
a. Non weight-bearing
b. Full weight-bearing
c. 10 pounds partial weight-bearing
d. Weight-bearing as tolerated - CORRECT ANSWER d. Weight-bearing as tolerated
Rationale: A patient with a grade II ankle sprain should have orders for weight-bearing as tolerated; some patients may need an assistive device as well. Protected weight-bearing is needed for a grade III ankle sprain.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 588, Table 23.1
A patient who recently started training for a marathon comes to the office with diagnosis of foot and ankle pain. After physical examination, the patient is diagnosed with Achilles tendinitis. The nurse should expect which of the following treatments to be prescribed for this patient?
a. Rest
b. Injection
c. Cast application
d. Surgery - CORRECT ANSWER a. Rest
Rationale: Noninvasive modalities are the foundation of treatment for Achilles tendinitis, especially rest and anti-inflammatory medications. Avoidance of uneven surfaces and inclines, along with a decrease in pace, is suggested during early rehabilitation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 590
The day after a basketball game, the patient is seen in the clinic with right knee pain. The patient describes going up for rebound and twisting the knee on landing. Assessment suggests the patient has a bucket handle tear of the body of the meniscus. An MRI is ordered. The nurse should recognize which of the following patient symptoms as also suggestive of this type of injury?
a. Crepitus
b. Locking
c. Swelling
d. Instability - CORRECT ANSWER b. Locking
Rationale: A bucket handle tear of the meniscus is a tear in the body of the meniscus that resembles a bucket handle. This type of tear frequently causes locking of the knee as the "handle" catches and prevents extension of the joint.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 580
A high school wrestler with a long history of anterior shoulder dislocations is scheduled for outpatient surgery for shoulder arthroscopy with possible repair. The patient and parents discuss the procedure with the surgeon and anesthesiologist, and they decide to have an interscalene block instead of general anesthesia. Following this type of brachial plexus block, the nurse should monitor for signs of
a. Horner's syndrome.
b. compartment syndrome.
c. Ehlers Danlos syndrome.
d. Marfan syndrome. - CORRECT ANSWER a. Horner's syndrome.
Rationale: Monitoring patients with a brachial plexus block includes evaluation of low oxygen saturation, chest heaviness, drooping of the eyes, and hoarseness; this set of symptoms is called Horner's syndrome. Marfan syndrome is a genetic disorder of connective tissue, not an acute complication of surgery. Ehlers Danlos syndrome is also a genetic disorder of connective tissue. Compartment syndrome is possible after orthopaedic surgery, but it is not a complication of a brachial plexus block.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 175
A patient reports "jamming" a finger on his right hand yesterday during a basketball game. The patient is seen in the Urgent Care Center and diagnosed with mallet finger. When the nurse reviews use of a prescribed splint for the injured finger, the patient asks how often he needs to wear the splint. The nurse should respond,
a. "During sports activities."
b. "As needed based on symptoms."
c. "At all times."
d. "At nighttime." - CORRECT ANSWER c. "At all times."
Rationale: Many types of finger splints can be used to treat mallet finger. The importance of using the splint at all times must be stressed to the patient, as consistent use is essential for proper healing with this type of injury.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 529
A patient with long-standing Paget's disease is seen in the clinic for routine laboratory testing. The nurse should expect which of the following to be included in the blood panel for this patient?
a. Alpha-fetoprotein
b. Vitamin D
c. Parathyroid hormone
d. Alkaline phosphatase - CORRECT ANSWER d. Alkaline phosphatase
Rationale: Alkaline phosphatase is needed to monitor ongoing bone remodeling and ongoing assessment of skeletal deformity in Paget's disease. Alpha-fetoprotein is used to help diagnose and monitor therapy for some cancers of the liver, testicles, and ovaries. Serum vitamin D is assessed for suspected rickets or osteomalacia. Parathyroid hormone can also identify deficiencies and osteomalacia.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 391
A female patient diagnosed with hypoparathyroidism returns to the clinic for a follow-up appointment. In reviewing the patient's documented history from the last visit, which of the following should the nurse expect to identify?
a. Constipation
b. Frequent urination
c. Anorexia
d. Flaking skin - CORRECT ANSWER d. Flaking skin
Reference: Dry, flaking skin may occur with hypoparathyroidism. GI symptoms include increased gastric motility with cramping and diarrhea. Anorexia, nausea, and vomiting are associated with hyperparathyroidism due to hypercalcemia. Frequent urination with polyuria can occur with hyperparathyroidism due to calcium loss that impairs renal water conservation.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 389
A patient with Parkinson's disease is seen in the clinic for routine re-assessment. The patient's spouse tells the nurse, "My husband is no longer showing any interest in sex." The nurse's response should be based on knowledge that sexual dysfunction in Parkinson's disease can be caused by loss of
a. serotonin.
b. dopamine.
c. norepinephrine.
d. glutamate. - CORRECT ANSWER b. dopamine.
Rationale: PD may cause sexual dysfunction due to the loss of dopamine, the principal neurochemical mediator of reward and pleasure in the brain.
Reference: Parkinson's Foundation. (n.d.). Sexual Health. Retrieved from https://www.parkinson.org/Living-with-Parkinsons/Managing-Parkinsons/Sexual-Health
A child with Duchenne muscular dystrophy is brought to the clinic by his mother for a routine visit. The nurse, who had previously reviewed her carrier status with the boy's mother, should also discuss the mother's risk for
a. cardiomyopathy.
b. renal insufficiency.
c. hepatic failure.
d. osteoporosis. - CORRECT ANSWER a. cardiomyopathy.
Rationale: Female carriers of DMD have a higher-than-average risk of developing cardiomyopathy. The American Academy of Pediatrics recommends that carriers should undergo a complete cardiac evaluation in late adolescence or early adulthood, or sooner if symptoms occur. They should also be evaluated every 5 years starting at ages 25-30. The other conditions are not linked to carrier status.
Reference: Muscular Dystrophy Association. (n.d.). Duchenne Muscular Dystrophy (DMD). Retrieved from https://www.mda.org/disease/duchenne-muscular-dystrophy/medical-management [Show Less]