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ONC Pediatric, Congenital,
Neuromuscular Conditions, Operative
Orthopaedics Practice Exam with
answers and Rationales
A surgical nurse is reviewing types of orthopaedic hardware with a nursing student. Which of the following screws should the nurse identify as using a guide wire for both drilling and screw insertion while maintaining proper bone position? a. Cancellous screw b. Cannulated screw c. Compression screw d. Cortical screw ✔b. Cannulated screw Rationale: A cannulated screw is the only one in this list with a hole that allows the screw to be inserted over a guide wire. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 111 A surgical nurse is preparing a patient for shoulder surgery. The nurse should identify which of the following as the appropriate position for this patient during the procedure? a. Prone b. Beach chair c. Lithotomy d. Jackknife ✔b. Beach chair Rationale: Beach chair and lateral are the two positions commonly used for shoulder surgery. Prone is for back surgery, lithotomy for obstetric/gynecologic procedures, and jackknife for rectal surgeries. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 45, 163 A surgical nurse is reviewing risk factors for surgical site infection (SSI) with orienting nurses. Which of the following should the nurse identify as a predisposing factor for SSI? a. Dose of cefazolin (Ancef®) 15 minutes before skin incision b. Total surgery time less than 2 hours c. Patient history of type 2 diabetes controlled by diet d. Patient fracture requiring external fixation ✔d. Patient fracture requiring external fixation
Rationale: A fracture that requires external fixation can increase a patient's risk for developing SSI. All the other options assist in reducing the chance of developing an SSI. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, pp. 75- A surgical nurse is preparing for an orthopaedic procedure that will involve grafting. Which of the following graft materials should the nurse identify as harvested from one individual and implanted into another individual of the same species? a. Allograft b. Autograft c. Xerograft d. Xenograft ✔a. Allograft Rationale: Allograft is harvested from one person and implanted into another person. Autograft comes from the same person, and xenograft is from a different species. Xerograft does not exist. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 92 A surgical nurse is circulating during performance of cemented total hip arthroplasty. Which of the following should the nurse identify as the most frequently occurring patient reaction to the use of polymethylmethacrylate (PMMA) cement during this procedure? a. Hemorrhage b. Hematoma c. Transitory increase in pain d. Transitory decrease in blood pressure ✔d. Transitory decrease in blood pressure Rationale: A transitory decrease in blood pressure is the most common patient reaction to use of PMMA cement. Other options occur infrequently. In particular, the transitory increase in pain may result from heat released during cement polymerization; however, it is not common. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 23 To avoid brachial plexus injury during upper extremity surgery, the surgical nurse should position the patient's arm in which of the following? a. Abduction of arm at less than 90 degrees b. Adduction of arm at more than 90 degrees c. Palms facing downward when arm is out on arm board d. Palms facing upward when arm tucked at side ✔a. Abduction of arm at less than 90 degrees
Rationale: Anterosuperior rotator cuff tears usually have a biceps tendon disorder. An open repair is needed to perform a biceps tenodesis which has been shown to provide better outcomes with better pain relief and shoulder function. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 165 The surgical nurse is assisting in internal fixation of a mid-shaft femoral fracture. The nurse should identify which of the following intramedullary nails as least stable? a. Reamed medullary nail b. Unreamed medullary nail c. Unreamed hollow medullary nail d. Flexible medullary nail ✔a. Reamed medullary nail Rationale: Reaming will cause the nail to enter into the canal eccentrically, which may lead to the distal fracture fragment being either too medial or too lateral. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 116 A surgeon asks for a periosteal elevator to visualize a fractured bone. The nurse should identify which of the following instruments for this purpose? a. Babcock b. Meyerding c. Verbrugge d. Cobb ✔d. Cobb Rationale: The Cobb is a chisel-like instrument that is designed to lift, or elevate, the periosteum from the bone. A Babcock is a grasping instrument made to grasp soft tissue or bowel. A Meyerding is a type of retractor used in spine surgeries, and a Verbrugge is a bone-holding forcep. Reference: Orthopaedic Surgery Manual (3rd ed.), 2017, p. 59 Which of the following should demonstrate the surgical nurse's understanding of tourniquet safety during performance of a total knee arthroplasty? a. The surgeon should be notified of tourniquet time at 120 minutes. b. The tourniquet is inflated with limb in dependent position. c. The tourniquet is inflated to 300-350 mm Hg. d. The surgeon should not need to exsanguinate the lower limb. ✔c. The tourniquet is inflated to 300-350 mm Hg. Rationale: The tourniquet is inflated to 300-350 mm Hg for use on the thigh. The surgeon needs to be notified at regular, established intervals of the duration of the tourniquet time; general agreement indicates the tourniquet should not be inflated longer than 90 minutes for a lower extremity procedure. The limb must be elevated and exsanguinated for this procedure.
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 130 In assisting with a lower extremity surgery, the surgical nurse should be aware that which of the following nerves can be compressed during surgery because of its superficial position at the lateral aspect of the fibular head? a. Pudendal b. Peroneal c. Tibial d. Sural ✔b. Peroneal Rationale: The common peroneal nerve arises from the sciatic nerve; it travels around the fibular neck and laterally around the fibular head. Most peroneal nerve injuries come from compression in this prominent region of the lateral ankle. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 128 The surgical nurse is preparing a patient to receive a Bier block before a procedure. The nurse should recognize this type of anesthesia as most appropriate for which of the following? a. Plantar fascia release b. Hammer toe release c. Bunionectomy d. Carpal tunnel release ✔d. Carpal tunnel release Rationale: The Bier block is used primarily for upper extremity surgery. This includes procedures such as carpal tunnel release and Depuytren contracture release. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 125 The parents of a child with cerebral palsy tell the nurse their son appears to have chronic pain secondary to muscle spasms. Which of the following interventions should the nurse recognize as the best initial intervention for managing the child's pain? a. Administer oral muscle relaxants b. Administer oral opioids c. Immobilize the affected extremity d. Reduce changes in position ✔a. Administer oral muscle relaxants Rationale: The source of pain is from the muscle spasms and contractions. Opioids often are not effective for this type of pain. Immobilization or reduced changes in position may not prevent muscular irritation and spasms. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 278
Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296 Parents bring their child with Duchenne's muscular dystrophy into the clinic for regular follow up. The nurse should know that the child's abnormal gait is due to muscle weakness in the a. ankle b. thighs. c. tibialis anterior. d. hip girdle. ✔d. hip girdle. Rationale: In a child who is ambulatory, observation of walking will reveal an abnormal gait due to weakness of the hip girdle muscles. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 284, table
A patient newly diagnosed with multiple sclerosis is discussing lifestyle changes with the nurse. Which of the following statements by the patient should indicate to the nurse that more education is needed? a. "I should go to bed and get up at the same time every day." b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations." c. "Exercise in water may help me move in ways I cannot move on land." d. "I might experience worsening of symptoms in humid weather." ✔b. "I should limit my intake of Omega-3 fatty acids to avoid exacerbations." Rationale: There is some evidence that a diet low in saturated fats and supplemented by Ometa-3 (from fatty fishes, cod-liver oil, or flaxseed oil) and Omega-6 (fatty acids from sunflower or safflower seed oil and possibly evening primrose oil) may have some benefit for people with MS; thus there is no reason to limit intake of Omega-3 fatty acids. As part of good sleep hygiene, experts recommend patients with MS go to bed and get up at the same time every day (and no more than 1 hour later on weekends). Water exercise may be especially beneficial to people with MS. Persons with MS can experience a temporary worsening of symptoms in hot, humid weather. Reference: National Multiple Sclerosis Society. (n.d.). The Omega-3 Factor. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Diet- Exercise-Healthy-Behaviors/Diet-Nutrition/Omega- A patient's husband brings her to the clinic for evaluation. He tells the nurse he is afraid his wife has Parkinson's disease. Which of the following, if described by the patient's husband, should the nurse recognize as suggestive of Parkinson's disease? a. Use of a loud voice b. Diarrhea c. Narcolepsy d. Angry facial expression
✔d. Angry facial expression Rationale: Facial masking is often described as a serious, depressed, or mad look on the face; although it can also be caused by some medications, it is common in patients with PD. A patient with suspected PD may experience constipation and trouble sleeping, and speak in a low or hoarse voice. Reference: Parkinson's Foundation. (n.d.). 10 Early Signs of Parkinson's Disease. Retrieved from https://www.parkinson.org/understanding-parkinsons/10-early- warning-signs A child recently diagnosed with juvenile myasthenia gravis is prescribed pyridostigmine (Mestinon®). In discussing possible medication side effects with the child's parents, the nurse should include which of the following? a. Headache b. Weight gain c. Diarrhea d. Mood changes ✔c. Diarrhea Rationale: Pryidostigmine tends to be a well-tolerated oral medication. However, it can have side effects such as abdominal cramps, diarrhea and, in very rare instances, worsening weakness. Mood changes and weight gain are likely to be associated with use of corticosteroids, while headache may result from treatment with intravenous immunoglobulin (IV Ig). Reference: Myasthenia Gravis Foundation of America. (n.d.). For Parents. Retrieved from https://myasthenia.org/Living-Your-Best-Life-With-MG/For-Parents A patient comes to the office with complaints of unaccustomed fatigue, new muscle weakness, joint pain, and increased difficulty tolerating cold temperatures. As part of his history, the nurse learns the patient migrated from Nigeria last year. Which of the following conditions should the nurse suspect is affecting this patient? a. Multiple sclerosis b. Muscular dystrophy c. Post-polio syndrome d. Parkinson's disease ✔c. Post-polio syndrome Rationale: There are long-term physical consequences to having had poliomyelitis. New symptoms recognized by the medical community that may relate to prior polio include unaccustomed fatigue - either rapid muscle tiring or feeling of total body exhaustion; new weakness in muscles, both those originally affected and those seemingly unaffected; pain in muscles and/or joints; sleeping problems; breathing or swallowing problems; and/or decreased ability to tolerate cold temperatures. In addition, only Afghanistan, Pakistan, and Nigeria have never stopped transmission of polio.
a. Dopamine b. Serotonin c. Acetylcholine d. Glutamate ✔a. Dopamine Rationale: Most symptoms of PD are caused by a lack of dopamine in the brain. Many drugs used for treatment of PD either try to replenish dopamine or mimic its effects. Reference: Parkinson's Foundation. (n.d.). Prescription Medications. Retrieved from https://www.parkinson.org/Understanding-Parkinsons/Treatment/Prescription- Medications A patient with multiple sclerosis tells the nurse she has read that MS can affect her cognitive abilities. The nurse should suggest activities such as board games and handiwork to enhance the patient's cognitive a. dissonance. b. distortion. c. load. d. reserve. ✔d. reserve. Rationale: The concept of cognitive reserve helps to explain why individuals with the same degree of brain changes due to aging or a neurological disease like MS may have very different cognitive function. Research has shown a lifetime of intellectual enrichment from education as well as stimulating work and leisure activities helps to lessen or slow the impact of disease- or aging-related changes in the brain. Reference: National Multiple Sclerosis Society. (n.d.). Cognitive Health. Retrieved from https://www.nationalmssociety.org/Living-Well-With-MS/Cognitive-Health The nurse's care of a patient with early amyotrophic lateral sclerosis (ALS) would be guided by the knowledge that which of the following can occur as a result of the disease? a. Hearing loss b. Urinary urgency c. Visual disturbances d. Episodic diarrhea ✔b. Urinary urgency Rationale: The patient with ALS can experience urinary urgency and will need bathroom assistance. Hearing and vision generally remain normal. The patient may experience abdominal bloating and constipation. Reference: Muscular Dystrophy Association. (n.d.). Amyotrophic Lateral Sclerosis: Signs and Symptoms. Retrieved from https://www.mda.org/disease/amyotrophic- lateral-sclerosis/signs-and-symptoms
The treatment of a child's femoral shaft fracture involves application of a hip spica cast. The nurse should instruct the caregivers to monitor for which of the following? a. Heel pressure b. Cast slippage c. Cast softening d. Skin breakdown ✔d. Skin breakdown Rationale: Skin breakdown is a significant risk with application of a spica cast. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 296 The nurse is reviewing pediatric orthopaedic problems with a class of nursing students. Which of the following should the nurse identify as the site of the most common upper extremity fracture in children? a. Clavicle b. Humerus c. Scapula d. Ulna ✔a. Clavicle Rationale: Clavicle (collarbone) fractures are extremely common in children. Reference: An Introduction to Orthopaedic Nursing (5th ed.), 2018, p. 28 When discussing the occurrence of slipped capital femoral epiphysis (SCFE) with the parents of a child newly diagnosed with the disorder, the nurse should explain that SCFE a. is more common in girls than boys. b. often occurs suddenly related to sports injury. c. is more common in toddlers and pre-schoolers. d. occurs commonly in adolescents and pre-adolescents. ✔d. occurs commonly in adolescents and pre-adolescents. Rationale: SCFE is the most common disorder of the hip in adolescents. Age range for boys is 10-17 years, with a peak incidence at ages 13-14. Age range for girls is 8- 15 years, with a peak incidence at age 11. It occurs two to three times more often in boys than in girls. This condition most likely occurs after a failed stress fracture experienced earlier in life. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 313- The nurse regularly sees a child with oligoarthritis. In addition to care from a rheumatologist, the nurse should ensure the child's parents understand the need to follow up regularly with which specialist?
d. able to play soccer in several weeks. ✔c. using crutches for ambulation initially. Rationale: A long-leg brace is not necessary, but activities such as unassisted weight bearing and soccer are not appropriate for the immediate recovery phase. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 316 The nurse is counseling the parents of a child who has been diagnosed with osteogenesis imperfecta. As they discuss ways to help the child attain independent mobility, the nurse should recommend which of the following? a. Thick casting for stability b. Gentle daily exercise to extremities c. Early participation in organized sports d. Avoidance of early weight bearing ✔b. Gentle daily exercise to extremities Rationale: Limiting weight bearing and casting will not aid in strong bone formation. Gentle exercises will keep the extremities functional and are unlikely to lead to fractures. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 307 The nurse provides information for the parent of a 10 year old with Blount's disease (tibia vara). Which of the following should the nurse include in the discussion of conservative management of this disorder? a. Restrict participation in usual activities. b. Follow-up x-rays are needed every 6 months. c. A brace may be worn during the day and removed at night. d. Manage the child's weight because obesity is a factor. ✔d. Manage the child's weight because obesity is a factor. Rationale: Participation in normal activities should not be discouraged for the child with BD. Follow-up x-rays should be done every 3 months, and the brace is to be worn full time. Inactivity can lead to weight gain, and obesity can be a factor in development of BD. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 270- The nurse is providing a class on childhood injuries for the staff at a local daycare center. Which of the following should the nurse identify as the joint most commonly affected by dislocation in children ages 2-5? a. Hip b. Knee c. Ankle d. Elbow
✔d. Elbow Rationale: Dislocation of the elbow often results from swinging activities that have the weight of the child pulling on the arm and elbow joint. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, pp. 517- A newborn diagnosed with clubfoot is scheduled to begin surgical treatment. Which of the following should the nurse stress with the parents? a. Performance of cast care b. Application of Bryant's traction c. Application of orthotics d. Careful handling of the infant ✔a. Performance of cast care Rationale: Because clubfoot treatment typically involves frequent cast applications, nursing interventions should focus on teaching patients cast care and signs of skin issues. Bryant's traction is sometimes used for treatment of developmental dysplasia of the hip. Orthotics may be used in treatment of myelomeningocele. Careful handling is particularly stressed for the child with osteogenesis imperfecta. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 280 A mother is troubled by the deformity in her infant's right foot and questions the treatment plan after diagnosis of metatarsus adductus. The nurse should explain likely treatment with a. passive hamstring stretching. b. serial casting. c. external fixation. d. tendon release. ✔b. serial casting. Rationale: Metatarsus adductus is managed by serial casting or bracing. The deformity yields more quickly when the cast is extended above the flexed knee, and the infant is also less likely to kick it off. Hamstring stretching is part of treatment for Osgood-Schlatter disease. Tendon release may be considered for painful contractures in a patient with muscular dystrophy. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 294 Developmental dysplasia of the hip (DDH) is suspected in an ambulatory 20-month- old child. If described by the child's mother, which of the following should the nurse associate with likely DDH? a. Scissoring of the legs b. Leg kicking in unison c. Toe walking d. Foot stiffness
d. "I will allow my child to use the home computer to complete long reports." ✔c. "I will get a large backpack so my child can carry books between school and home." Rationale: A child with JIA should have two sets of books so he or she does not have to carry them between school and home. Other options represent good support strategies by the mother. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 339 A 12-year-old child has been diagnosed with a scoliotic curve of 15 degrees. The nurse should confirm which of the following with the child's parents as part of the plan of care for this patient? a. Observe regularly for progression. b. Fabricate a brace for nighttime use. c. Add counterweights to halo traction. d. Schedule posterior spinal fusion. ✔a. Observe regularly for progression. Rationale: Most curves less than 15-20 degrees are observed for progression at 6- month intervals during peak growth and annually otherwise; they are unlikely to progress further. Other options are appropriate for greater curves. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451 The nurse is providing a class on signs of physical abuse for the staff at a local daycare center. Which of the following should the nurse identify as most likely to receive fractures of the hands or feet as a result of physical abuse? a. 8 year old b. 6 year old c. 4 year old d. 2 year old ✔d. 2 year old Rationale: Fractures of the hands or feet in infants and young toddlers commonly result from physical abuse. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 311, Table
Parents bring their 6-year-old child to the clinic for evaluation of pain localized to the groin and the medial aspect of the thigh. They tell the nurse the child's pain has continued for several months and has been aggravated by activity. The nurse observes the child has an antalgic limp. Which of the following should the nurse expect as the diagnosis? a. Blount's disease b. Legg-Calve-Perthes disease
c. Achondroplasia d. Neurofibromatosis ✔b. Legg-Calve-Perthes disease Rationale: A child with Legg-Calve-Perthes disease may present with mild pain localized to the groin or medial aspect of the thigh or knee. The child often has had pain and a limp for several months before being seen by a healthcare provider. Blount's disease involves a pathologic bowing of the legs; it is considered a growth disorder involving the proximal tibial growth plate. Achondroplasia is also a disorder of the growth and remodeling of bone and cartilage. The identified symptoms are not typical of neurofibromatosis. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 289 The nurse is discussing bracing with the parents of a child with scoliosis. The nurse should tell the parents that a new brace needs to be fabricated for a growing child every a. 2-4 months b. 6 months c. 10 months d. 12-18 months ✔d. 12-18 months Rationale: As the child grows, a new brace needs to be fabricated every 12- months. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 451 When bracing is prescribed for a child with Blount's disease, the child's caregivers ask the nurse the purpose of this treatment. Which of the following should the nurse identify? a. Provide medial stability for the knee joint b. Internally rotate the leg c. Relieve stress on the medial tibial metaphysis d. Counteract lateral compressive forces ✔c. Relieve stress on the medial tibial metaphysis Rationale: Bracing is an option to relieve excessive stress on the medial tibial metaphysis, to provide lateral stability to the knee joint, and to externally rotate the leg. A locked brace counteracts the pathologic medial compressive forces, allowing resumption of normal growth and correction of deformity. Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 271 A child with suspected Osgood-Schlatter disease complains of pain when bicycling. Which of the following sites for the child's pain should the nurse identify as supporting this diagnosis?
