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ONC Certification study Cards Exam 165 Questions with Verified
Answers
What age does bone density peak for most people? - CORRECT ANSWER age 30 A 14 year old fell during a baseball game suffering first degree ankle sprain, physician rec standard conservative tx for 24 hours then contrast baths, which correctly describes contrast baths - CORRECT ANSWER soak foot in cold water for 15 min followed by warm for 15 min QID during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER use of ankle splints which of the following is the definitive diagnostic test for juvenile idiopathic/rheumatoid arthritis - CORRECT ANSWER there is no definitive test for this which of the following is a method to relive pressure on the back for people whose work requires prolonged standing? - CORRECT ANSWER place one foot on a small stool or box what is the greatest risk in the immediate postoperative period for patients who suffer orthopedic traume requiring reconstructive surgery of the lower extremeties? - CORRECT ANSWER pulmonary embolism which of the following statements by the parent of a child with systemic juvenile idiopathic/rheumatoid arthritis (still's diesease) indicates a need for further education about the diesease - CORRECT ANSWER my child no longer has symptoms so i dont think she needs the medications which of the following patients is the best candidate for surgical repair of a ruptured achilles tendon? - CORRECT ANSWER 40 year old male in good general health
using the symptom based diagnostic criteria of the american college of rheumatology for diagnosis of fibromyalgia, which of the minimal scores is consistent with the diagnosis - CORRECT ANSWER widespread pain index score of
or equal to 7 and symptom severity score of > or equal to 5 which of the follow heat producing therapies is most indicated for pain and stiffness of large joints such as shoulder or hip? - CORRECT ANSWER short wave diathermy what soft tissue penetrance does superficial heat such as paraffin baths or moist heat packs provide? - CORRECT ANSWER 1-2cm when using cryotherapy for an athletes foot, what is the max length of time the foot should be immersed in an ice bath at each treatment? - CORRECT ANSWER 20 minutes when using vapocoolant spray to facilitate stretching of the muscle after a hamstring injury, how far away from the skin should the spray container be held when spraying the skin? - CORRECT ANSWER 12 incehs which of the following tx is contraindicated for patients with a pacemaker? - CORRECT ANSWER TENS treatment A football player is to use a whirlpool bath to relieve muscle pain and stiffness what temperature should the water be maintained at? - CORRECT ANSWER 95- 104 degrees fahrenheit women of childbearing age taking oral methotrexate for tx of rheumatoid arthritis should utilize birth control for what period - CORRECT ANSWER during tx and through one ovulatory cycle after tx which of the following is correct advice for patient during periods of exacerbation of rheumatoid arthritis affecting the knees? - CORRECT ANSWER avoid positions of flexion
what is the most common indication of advanced osteoporosis - CORRECT ANSWER kyphosis when assessing a patient gait, the ortho nurse notes that the patient appears unsteady and uncoordinated with a wide base measurement and lifts feet higher than normal while stepping with feet flat onto floor. how is gait characterized? - CORRECT ANSWER atAxia children with duchennes muscular dystrophy should be assessed for bone density beginning at about what age? - CORRECT ANSWER 3 years a patient with psoriasis develops marked edema of the fingers and toes (dactylitis) what does this probably indicate? - CORRECT ANSWER psoriatic arthritis a patient must wear a wrist immobilization splint, but the splint tends to migrate as the patient moves the fingers and elbow, which of the initial measures indicated to reduce friction and migration? - CORRECT ANSWER cover skin with stockinet or elastic tubular bandage like tubigrip for which of the following common complications should an infant with achondroplasia be monitored? - CORRECT ANSWER hydrocephalus and otitis media a patient complains of bouts of recurring pain, erythema and swelling at the base of the right big toe with sudden onset and symptoms persisting 3-10 days what are the symptoms consistent with? - CORRECT ANSWER acute gout during the physical examination of a patient, the orthopedic tech notes nodules on the dorsolateral aspects of teh distal interphalangeal joints (herberden's nodules) what does this finding indicate - CORRECT ANSWER osteoarthritsi a patient who has rheumatoid arthritis and whose functional status is class 3, should be able to perform which of the following? - CORRECT ANSWER can carry out usual activities involving self care but limited in work and other activities
a 16 year old adolecent playing basketball sprains his ankle (grade II inversion injury) what tx is most likely? - CORRECT ANSWER RICE for tx of osteoporosis, which of the following agents stimuates the formation of bone? - CORRECT ANSWER teriparatide (forteo) according to the 3 step world health organization analgesic ladder "a patient complaining of moderate to severe pain unresponsive to NSAIDS may require which of the following medications? - CORRECT ANSWER CODEINE How should a child with juvenile idiopathic/rheumatoid arthritis be positioned in bed? - CORRECT ANSWER no support under knees and no or ver low pillow under head (to maintain extension) a bed bound patient has a 1.5 inch foam overlay over her mattress, the nurse places her hand under teh overlay and finds that it has compressed to 0. inches, what does this indicate? - CORRECT ANSWER bottoming out With the times up and go test to assess ambulation and mobility, which time shows an increase risk for falls? - CORRECT ANSWER 14 seconds a patient has had an open reduction of a potts fracture and has a still damp short leg cast, a small spot of blood appears on the cast what action should the nurse take? - CORRECT ANSWER time date and circle the spot a patient with systemic lupus has developed swollen tender joints, increased fatigue and weakness, low grade fever, mild depression, and loss of appetite. She has a rash present on her face. lab finding show increased ESR which of following is likely tx? - CORRECT ANSWER nsaids and corticosteroids a 70 year old patient with fracture of the proximal femur develops sudden onset of hypoxia, tachypnea, high fever, buccal and conjuctival petichaiae and tachycardia 24 hours after injury, initial blood gasses indicate respiratory alkalosis, which complication is most likely the cause. - CORRECT ANSWER fat embolism syndrome.
36 year old female has bee training to run a marathon but develops increasing pain while running and point tenderness in shine. x ray is negative for fx what further test is indicated? - CORRECT ANSWER bone scan 36 year old male falls on elbow, extremely painful and flexed at 60 degree angle. spasms are occuring but circulation is good. what do you do? - CORRECT ANSWER attempt to securely splint arm without attempting to change flexion patient with end stage bone cancer has elected hospice and palliative care. having extreme sever bone pain from tumor, physican order radiotherapy to reduce tumor size and reduce pain. is this acceptable under hospice? - CORRECT ANSWER yes if purpose is to relive pain, it is essentially palliative patient is to begin zometa for bone metastasis, what lab test is indicated prior to each dose? - CORRECT ANSWER creatinine/clearance which infection control precautions should be used when caring for a patient with osteomyelitis and a fistula infected with staph aureus? - CORRECT ANSWER standard and contact what is the most common complication of pagets diesease? - CORRECT ANSWER fracture a patient with a hip spica cast complains of feeling severely claustrophobic which intervention is most effective - CORRECT ANSWER cut a windown above patient abdomen patient is receiving high doses of vitamin d to treat oseomalacia what dietary intervention is also indicated - CORRECT ANSWER diet high in vitamin c and phosphorus a patient is screen for oseoporosis by a bone mineral density test which of the following score indidcates osteopenia? - CORRECT ANSWER -1. when assessing a patient gait and posture how far apart should a patient s heels be as they pass while walking? - CORRECT ANSWER 2-4 inches
what is the primary concern for the orthopedica nurse when monitoring a patient with a new cast on a an upper extremity - CORRECT ANSWER neurvascular status which of the following neurovascular injuries is associated with distal radius fracture - CORRECT ANSWER median nerve injury a patient experienced a traumatic posterior acetabular (hip) dislocation in an auto accident. which complication is most often associated with this type of dislocation. - CORRECT ANSWER Sciatic nerve injury the ortho nurse is assessing a patients elbow ROM which actions are within the elbows normal ROM? - CORRECT ANSWER flexion, extension, pronation, supination which of the following results in indicative of developmental /congenital hip dysplasia in a 6 month old child. - CORRECT ANSWER positive allis sign a newborn was diagnosed with Osteogenesis imperfecta type 1 at birth based on rib fracture blue sclera and short limbs. what critical info should the parents receive before going home? - CORRECT ANSWER correct methods of handling, bathing, and placing child in the crib two year old chilld dis place in bryant traction because of femur fx which position is correct? - CORRECT ANSWER buttocks slightly elevated off of the bed an adolescent female has been fitted with a milwaukee brace for kyphoscoliosis but she has developed skin irritation with areas of denuded skin and tenderness over pelvic bones from wearing the brace what caused this? - CORRECT ANSWER pelvic piece is too loose a foot drop splint used for peroneal nervne palsy would be classified as which type of orthotic? - CORRECT ANSWER functional a patient with an injured leg imagines how it feel sto extend and flex the limb in normal range of motion and imagines walking and using the limb, what is this technique? - CORRECT ANSWER visualization
pt who suffered a traumatic fx has developed signs of acute compartment syndrome. compartment pressure is 32 mm hg and bp is 110/60 what is patients delta pressure? - CORRECT ANSWER 28 mm hg (diastolic-CP = DP) patient involved in a skiiing accident incurred a rupture of the ACL what inital tx is usually indicated? - CORRECT ANSWER knee brace a trauma victim has been admitted to the unit with fractures of the upper two ribs on the right side resulting from an auto accident. patient should be assess for what secondary injury or injuries? - CORRECT ANSWER tracheal/bronchial/great vessel trauma an infant has congenital metatarsus adductus with curvature of less than 13 degrees what should the ortho nurse expect to teach parents.... - CORRECT ANSWER stretching exercises when checking nerve function in the hand the "ok" sign and abductor pollicis brevis test are used for which nerve? - CORRECT ANSWER median 32 year old woman with autoimmunde myesthenia gravis has fluctuation but increasing muscle weakness and has begun to sleep in her chair because she sleeps better sitting upright. she yawns and sighs frequently which intervention is most appropriate with these symptoms? - CORRECT ANSWER respiratory assessment with pulmonary function tests. 35 year old female involved in a side impact automobile collision suffered pronouced cervical rotation and complains of severe right sided neck pain and severe unremitting right side headache and exhibits ecchymosis and swelling of right neck and right opthalmic ptosis with contraction of the pupil what is most likely reason for symptoms. - CORRECT ANSWER carotid dissection the use of which of the following medications puts patient at risk for defective vitamin D metabolism and osteomalacia? - CORRECT ANSWER phenytoin what triad of s/s is associated with familial x linked hypophostphatemia (XLH) - CORRECT ANSWER stunted growth, deformities of the lower extremeties, and hypophosphatemia
which of the following is the best dietary source of vitamin d - CORRECT ANSWER fortified dairy products which of the following disorders can result in renal osteodystrophy - CORRECT ANSWER chronic kidney diesease patient receiving antimalarials for rheumatoid arthritis should be monitored for which opthalmic disorder - CORRECT ANSWER macular degeneration which site of pain is usually present at the onset of ankylosing spondylosis - CORRECT ANSWER sacroilliac pain a patient with RA plans to do aquatic exercises at a local pool what water temp is optimal? - CORRECT ANSWER 85-94 degrees fahrenheit boutonniere deformity is characteristic of which disorder? - CORRECT ANSWER RA! amyloidosis (protein in the organs) secondary to RA is associated with which of the following? - CORRECT ANSWER kidney failure patient scheduled for hyaluronic acid (Orthovisc) injection to teh knee for tx of osteoarthritis. what allergy should nurse question for prior to tx? - CORRECT ANSWER chicken patient has injury to the right knee, what is the correct instruction for the patient use of cane? - CORRECT ANSWER cane in left hand and move cane and right leg forward together when examining a patient, the nurse notes that passive exercise results in cogwheeling (jerky incremental movements) cogwheeling is characteristic of which of the following dieseases? - CORRECT ANSWER parkinsons diesease which of teh following is a primary use of electrical muscle stimualtion? - CORRECT ANSWER relieve muscle spasms and increase muscle size
which of the following ismost indicative of a closed fracture in lower extremity? - CORRECT ANSWER inability to walk immediately and in the ER when assessing sensation of the radial nerve for a pt with a fracture of the humerus where should the nurse prick the skin? - CORRECT ANSWER midway between thumb and index finger screen for osteoporosis should begin routinely for all women at what age - CORRECT ANSWER 65 which of the following in addition to rest is teh most important intervention of fat pad contusion? (policemans heel) - CORRECT ANSWER shock absorbing insoles or heel pads which joint is the most commonly injured in sports - CORRECT ANSWER ankle a female golfer has developed a mortons neuroma of the right foot and has been advised to wear a wide toed shoe,, what other footwear modification is needed? - CORRECT ANSWER metatarsal rasie a child with polyartivular JI/RA is non responsive to other drugs and is going to receive a TNF blocking agent (Infliximab) remicade what test must be completed prior to admin of med - CORRECT ANSWER TB test which of the following injuries is common to ballet dancers because of postions the foot in placed in? - CORRECT ANSWER sinus tarsi syndrome a 30 year old expert in martial arts developed turf toe from excess flexion of great toe. once injury has healed what precautions should the patient use to prevent reinjury - CORRECT ANSWER wear a brace to support the toe or hard soled shoes in the adult which type of bone produces the greatest number of red blood cells?
- CORRECT ANSWER flat bones following closed reduction of a should dislocation what exercises are indicated after initial resting period - CORRECT ANSWER gentle rang of motion
a construction worker fell feet first form an eight foot ladder onto a concrete floor. which type of spinal fracture should be suspected? - CORRECT ANSWER axial burst which type of skull fracture results in widening of the sutures in children under age 3? - CORRECT ANSWER diastatic a womn experience sever hyperextension of the head and neck when he hair was caught in mechanical equipment at her place of employment what type of injury is common with this type of hyperextension? - CORRECT ANSWER primary brainstem lesion a conscious and responsive pt is brought to hospital by friends following fall off a roof resulting in severe back pain. what is initial intervention - CORRECT ANSWER immobilize pt when grading reflexes in lower extremeties, how is normal reflex activity graded - CORRECT ANSWER 2 when assessing a patient right lower ext for sensation the patient reports that the pinprick feels like pressure only and does not feel the sharp compared to the normal response felt on the left side, how is this response graded? - CORRECT ANSWER absent the risk for fat embolism is highest with which of the following fractures? - CORRECT ANSWER comminuted fracture of the tibia patient who has a thigh wound or amputation of teh lower extremity and is incontinent of stool is most at risk for what type of infection? - CORRECT ANSWER gas gangrene (clostridium perfrigens) children with oligoarticular JI/RA ar particularly at risk for which of the following - CORRECT ANSWER anterior uveitis (inflammation of middle layer of eye) and chronic iridocyclitis (inflammation of the iris) a patient with acute lower backpain spent one day on bedrest and is now able to move about but still has marked lower back pain. what are the time limits for
congenital muscular torticollis - CORRECT ANSWER constant unilateral contraction or tightness in the steronucleomastoid muscle in teh neck. parents note lack of head movement to one side or a knot that is felt along the proximal attachment side of the tightened muscle on the sternum. tx is primarily PT , massage bracing and postioning. Signicant proportion of children with this will also have hip dysplasia describe pigeon toeing - CORRECT ANSWER not described as a disorder under age of 2 secondary to a slightly rotated tibial bone. usualy does not require tx. in child over the age of 3 may signify twisting of femur. bracing and PT have not proven effective. surgery is only indicated if condition causes pain, disability or significant assymetry. describe clubfoot - CORRECT ANSWER tallipes equinovarus can be unilateral or bilateral. foot postioned abnomally in 3 different directions. 1. heel points medially and is inverted. 2. ankle points in the inferior direction. third. entire foot appears supinated (plantar surface up) tx is manual manipulation with splinting and casting with frequent follow up and gradual anatomic positioning. prognosis good with early tx bowlegs and knock knees "Genu Varum" - CORRECT ANSWER anomaly in which tibia and fibula are angled medially in relation to femur. most noted in children under 2 usually resolve themselves if not bracing is successful into the third decade. Surgery is only indicated if affecting growth or is assymetrical. reassurance of parents is priority that thsehse conditions are most often outgrown
primary concern in child born without limb - CORRECT ANSWER assure health and stabilization of newborn then, parents needs counseling, reassurance, education, and support. medical specialty evaluation is necessary for to further reassure parents and alleviate anxiety Leg-Calve-Perthes diesease LCP - CORRECT ANSWER head of femur deteriorates due to temporary lack of bood supply. more males than females ages 3-9. other risk factors are short stature, low birth weight, second hand smoke exposure, and first borns. more often unilateral. TX. self limiting,but with bracing, pain management and physical therapy prognosis is good. Education on healing time and diesease progression are essential. Complications of noncompliance: decreased ROM, early onset osteoarthritis three Tx options for limb length discrepancies - CORRECT ANSWER TX only a consideration greater than 1 inch descrepancy or if gait disturbance and pain
- shoe lift are initial tx of choice
- leg shortening surgical procedure primary for skelatally immature. however, results not immediate and complication of miscalculation is high
- leg lengthening tx for skeletally mature reliable and compliant pt. lengthy process and frequent follow up. infection risk high due to external fixator use spina bifida - CORRECT ANSWER congenital disorder in which development of brain or spinal cord and covering is abnormal. four types: occulta, closed neural tube defect, meningocele and myelomeningocele ortho considerations of myelomeningocele - CORRECT ANSWER most severe form of spina bifida. requires multi medical team approach to tx as well as patient and caregiver education. deformities will most likely develop in lower extremeties such as
and remissed. hands, wrists, shoulders, knees, and feet are most often affected bilaterally swan neck deformity, boutonniere deformity - CORRECT ANSWER swan neck: fingers- DIP and MCP joints in flexion while PIP joint is hyperextended. TX is splints, anti rheumatic drugs or surgical option such as tendon release (RA deformity) Boutonniere-fingers-Hyperextension of DIP jointand Flexion of PIP joint. TX is NSAIDS, Diesease modifying anti rheumatics, splinting and OT. Surgery is last resort. Seen in RA and "Jamming a Finger" Pharmacologic TX for RA - CORRECT ANSWER Cornerstone tx: Diesease modifying anti rheumatic drugs. Slow progression and joint deformities. encourage remission. Acute exacerbations: NSAIDS, COX-2 inhibitors, and corticosteroids. Plaquenil is shown to help modify course of RA New class of medications called Biologics, injectable and IV only. All used in cominations for best disease control. Nursing MGMT of RA - CORRECT ANSWER Controlling pain and maintaining function are most important. patient education especially on pain management and compromised immune system management are very important. ADLS including self care and hobbies Juvenile Rheumatoid Arthritis-3 types - CORRECT ANSWER similar to adult RA but patients under 16 and most children grow out of diesease. Polyarticular-most common- involves greater than 5 joints, sudden onset, most likely to have permanant joint damage. pauciarticular- 4 or less joints more often in lower extrememties. has major complication before age 6 of chronic eye problems systemic JRA- recurring spiking fevers and truncal rash in addition to joint pain. can get pericarditis Challenges and considerations Nursing MGMT of JRA - CORRECT ANSWER younger the child the harder to describe symptoms they are feeling. therapy and splinting are essential. maintaining self esteem and school participation must be done. everyone in contact should be educated
Ortho exam findings and considerations in pt with systemic lupus erythematosus - CORRECT ANSWER butterfly rash on cheeks, erythemous plaques on body, Differences of RA and SLE - CORRECT ANSWER both autoimmune disorders. musculoskelatal system is primary target in RA SLE affects more distal joints while RA does distal as well as all other joints. SLE onset is earlier in life than RA during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER during the acute stage of rheumatoid arthritis affecting the ankles, what primary precaution should the patient use to protect the ankle joints - CORRECT ANSWER
