ONCB ONP-C Practice Exam Teaser
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An NP evaluates a patient with knee pain whose x-rays demonstrate early osteoarthritis. Based on the AAOS Evidence-Based Clinical Guidelines for the Treatment of Osteoarthritis of the Knee (2nd Edition), which treatment option should the NP prescribe with highest confidence of success?
Low-impact aerobic exercise
Glucosamine and chondroitin
Question 1 Explanation:
Key: c Reference: AAOS Evidence-Based Clinical Practice Guidelines, Treatment of Osteoarthritis of the Knee (2nd ed.) (http://www.orthoguidelines.org/topic?id=1005) Rationale: Strong evidence has shown beneficial outcomes for patients with symptomatic knee OA from participation in self-management programs as well as strengthening and low-impact aerobic exercises consistent with national guidelines. Moderate evidence supports the benefit of weight loss. AAOS recommends strongly against use of arthroscopic lavage, acupuncture, or glucosamine and chondroitin supplements.
A patient is seen in the clinic for preoperative evaluation before total knee arthroplasty. After reviewing the patient’s list of medications, the NP should instruct the patient to hold which of the following 24 hours before surgery?
Question 2 Explanation:
Key d Reference: Essentials of Musculoskeletal Care (4th ed.), p. 171 Rationale: Patients taking oral hypoglycemic drugs should withhold their medications in the 24 hours before surgery. Metformin is the only listed drug indicated for diabetes.
The NP is designing a study about the impact of osteoarthritis on families and communities. Which of the following statements reflects an ethical issue the NP should consider for this study?
Monetary incentives limit the ability of participants to provide voluntary consent.
Subject assent is not required for research involving grade school-aged children.
Participants such as the poor or persons with limited education require special protection.
Potential benefits to the community override the concern for subject vulnerability.
Question 3 Explanation:
Key: c Reference: Polit & Beck, Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.), p. 149 Rationale: In conducting research, additional procedures may be required to protect the rights of special vulnerable populations (e.g., the poor or persons with limited education). Researchers interested in studying high-risk groups should understand guidelines regarding informed consent, risk/benefit assessment, and acceptable procedures for such groups. Monetary incentives are useful for participant recruitment and retention, particularly when the group under study is difficult to recruit. Legally and ethically, children do not have competence to give informed consent; parents or legal guardians must provide consent. Potential community benefits never override the rights of individual subjects.
A lumberjack suffers an injury to his leg after falling from a tree and having a large limb land on his thigh. X-rays reveal no fractures but the thigh is severely swollen and painful. Distal pulses are weak and capillary refill is delayed. The NP should suspect compartment syndrome and confirm this diagnosis with which of the following measurements?
Blood pressure 130/62 mm Hg, compartment pressure 45 mm Hg
Blood pressure 160/70 mm Hg, compartment pressure 35 mm Hg
Blood pressure 108/45 mm Hg, compartment pressure 30 mm Hg
Blood pressure 93/35 mm Hg, compartment pressure 25 mm Hg
Question 4 Explanation:
Key b Reference: Armstrong, A.D., & Hubbard, M.C. (Eds). (2015). Essentials of Musculoskeletal Care (5th ed.), p. 58 Rationale: Acute compartment syndrome is determined by subtracting the compartment pressure from the diastolic blood pressure (perfusion pressure). A difference of 20 mm Hg or more is diagnostic of acute compartment syndrome. Option B is the only measurement with a difference greater than 20.
The NP is working with an interprofessional group of sports medicine professionals. In formulating plans for medical supervision of a local high school soccer team, the NP and colleagues should identify which of the following as a potential ethical issue?
Preparation of a brief factual statement about player injuries for local media
Requirement of at least two full practices without restriction before allowing return to competition
Pre-season screening for history of cardiac disease
Use of corticosteroid injections to promote play
Question 5 Explanation:
Key: d Reference: Essentials of Musculoskeletal Care (5th ed.), pp. 244-246 Rationale: Ethical issues in sports management include use of performance-enhancing drugs and overzealous administration of corticosteroids to promote playing while injured. Pre-season screening for history of cardiac disease is beneficial, and an echocardiogram or electrocardiogram should be obtained if warning signs for disease are present. For all athletes, a gradual return to play should include transition from light or partial to full practice before returning to competition. When team medical personnel are approached by members of the public about the status of an injured athlete, a practical strategy is to prepare a brief factual statement that contains no confidential details.
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