A 66-year-old client in the orthopaedic clinic reports chronic right knee pain and stiffness. Which additional finding is most consistent with osteoarthritis rather than rheumatoid arthritis?

Morning stiffness that eases within about 30 minutes of moving around

Warm, boggy synovial swelling of several small joints on both sides of the body

Morning stiffness lasting well over an hour along with fatigue and low-grade fever

Symmetric swelling of the wrists and metacarpophalangeal joints of both hands

A client with a confirmed L4-L5 disc herniation compressing the L5 nerve root is admitted for pain control. Which finding should the nurse expect?

Numbness over the top of the foot and weak great toe extension

Numbness of the little finger with weakness of hand grip on the same side

Decreased Achilles reflex with numbness along the lateral border of the foot

Decreased patellar reflex with weak knee extension and medial leg numbness

A client is seen in the orthopaedic clinic 6 weeks after open reduction and internal fixation of a tibial shaft fracture. Radiographs show minimal callus. The client has type 2 diabetes, rarely checks blood glucose, and has a hemoglobin A1C of 10.4%. Which teaching point is most important for promoting fracture union?

Improve blood glucose control, because hyperglycemia slows bone healing

Take an over-the-counter NSAID daily to keep inflammation under control

Keep the leg completely still until the hardware is surgically removed

Limit dietary protein so the kidneys are not strained during healing

A college wrestler had an arthroscopic meniscal repair of a peripheral tear. His teammate had a partial meniscectomy last season. Which statement by the wrestler indicates understanding of his postoperative plan?

I'll need to follow weight-bearing and brace limits longer than he did.

I can stop wearing my brace as soon as the knee stops hurting at rest.

I can return to deep squats next week, since the tear has been fixed now.

My recovery should be faster than his because my meniscus was saved.

A client who has received denosumab injections every 6 months for 5 years tells the nurse, "My bones are better now, so I'm going to skip the next shot and stop." Which response is most important?

Stopping without a follow-up medication can cause rapid bone loss and spine fractures.

You can stop safely if you keep taking calcium and vitamin D supplements.

Stopping is fine, but you will need a dental cleaning before you stop the drug.

That's reasonable, because denosumab stays bound to bone and protects it for years.

A 64-year-old client is evaluated for osteoarthritis of the right hip. Which assessment findings should the nurse expect?

Groin pain with weight bearing and limited internal rotation of the hip

Lateral hip pain that is worst when lying on that side at night

Hot, red swelling of the hip with fever and refusal to move the leg

Low back pain radiating below the knee with a positive straight-leg raise

A client has a C5-C6 cervical disc herniation compressing the C6 nerve root. Which finding should the nurse expect?

Numbness of the thumb and index finger with weak wrist extension

Numbness of the middle finger with a decreased triceps reflex

Numbness over the outer shoulder with weak shoulder abduction

Numbness of the little finger with weak finger spreading and grip

A client with an unstable thoracolumbar burst fracture is on spinal precautions while awaiting surgical stabilization. The nurse needs to turn the client to inspect the skin on the back. Which technique is correct?

Logroll with at least three staff, keeping the shoulders and hips aligned

Turn the shoulders first, then bring the hips over once the trunk is turned

Have the client grasp the side rail and pull over onto the unaffected side

Raise the head of the bed to 45 degrees before turning the client to the side

A 15-year-old dancer had a first-time lateral patellar dislocation that reduced when she straightened her knee. Radiographs show no fracture, and she is treated nonoperatively. Which teaching point is most accurate?

Quadriceps and hip strengthening helps prevent another dislocation

Once the kneecap is back in place, it cannot dislocate again later

The knee should be kept completely straight for 6 months to let it heal

A brace is needed only while sitting, since standing protects the knee

A 69-year-old client with osteoporosis and a healed vertebral compression fracture asks how to lift a laundry basket safely at home. Which technique should the nurse teach?

Hold the basket close, keep the back straight and bend at the hips and knees.

Twist at the waist to swing the basket onto the counter in one smooth motion.

Bend forward at the waist with knees straight and lift the basket with both arms.

Hold the basket at arm's length and round the back to reach it from the floor.

Orthopaedic Nurses Certification Exam

Free Orthopaedic Nurse Practice Questions

10 sample questions for the Orthopaedic Nurses Certification Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Degenerative Disorders: The Spine and Other Degenerative Conditions, Orthopaedic Nursing Foundations: Assessment, Pain, Complications and Perioperative Care, Sports Injuries, Inflammatory Disorders, Metabolic Bone Disorders, Congenital and Pediatric Disorders, Musculoskeletal Tumors.

Question 1 · Degenerative Disorders: The Spine and Other Degenerative Conditions
A 66-year-old client in the orthopaedic clinic reports chronic right knee pain and stiffness. Which additional finding is most consistent with osteoarthritis rather than rheumatoid arthritis?
- A.Warm, boggy synovial swelling of several small joints on both sides of the body
- B.Morning stiffness lasting well over an hour along with fatigue and low-grade fever
- C.Morning stiffness that eases within about 30 minutes of moving around
- D.Symmetric swelling of the wrists and metacarpophalangeal joints of both hands
Show answer and explanation
Answer: C. Morning stiffness that eases within about 30 minutes of moving around
Osteoarthritis typically causes brief stiffness after rest (usually under 30 minutes) that improves with movement. Symmetric small-joint involvement, prolonged morning stiffness over an hour, systemic symptoms, and boggy synovitis are hallmarks of rheumatoid arthritis.
Question 2 · Degenerative Disorders: The Spine and Other Degenerative Conditions
A client with a confirmed L4-L5 disc herniation compressing the L5 nerve root is admitted for pain control. Which finding should the nurse expect?
- A.Numbness of the little finger with weakness of hand grip on the same side
- B.Decreased Achilles reflex with numbness along the lateral border of the foot
- C.Numbness over the top of the foot and weak great toe extension
- D.Decreased patellar reflex with weak knee extension and medial leg numbness
Show answer and explanation
Answer: C. Numbness over the top of the foot and weak great toe extension
The L5 root supplies sensation to the dorsum of the foot and the great toe and powers great toe extension (extensor hallucis longus). A reduced Achilles reflex with lateral foot numbness fits S1, a reduced patellar reflex with weak knee extension fits L4, and little finger numbness reflects C8 or the ulnar nerve.
Question 3 · Orthopaedic Nursing Foundations: Assessment, Pain, Complications and Perioperative Care
A client is seen in the orthopaedic clinic 6 weeks after open reduction and internal fixation of a tibial shaft fracture. Radiographs show minimal callus. The client has type 2 diabetes, rarely checks blood glucose, and has a hemoglobin A1C of 10.4%. Which teaching point is most important for promoting fracture union?
- A.Take an over-the-counter NSAID daily to keep inflammation under control
- B.Keep the leg completely still until the hardware is surgically removed
- C.Improve blood glucose control, because hyperglycemia slows bone healing
- D.Limit dietary protein so the kidneys are not strained during healing
Show answer and explanation
Answer: C. Improve blood glucose control, because hyperglycemia slows bone healing
Poorly controlled diabetes impairs blood flow, osteoblast activity and callus formation and is a major modifiable risk factor for delayed union and nonunion, so improving glucose control with the provider is the priority teaching. Long-term NSAID use may slow bone healing, and adequate protein is needed to build callus. Prolonged complete immobility is not required and promotes stiffness, atrophy and venous thromboembolism.
Question 4 · Sports Injuries
A college wrestler had an arthroscopic meniscal repair of a peripheral tear. His teammate had a partial meniscectomy last season. Which statement by the wrestler indicates understanding of his postoperative plan?
- A.I can stop wearing my brace as soon as the knee stops hurting at rest.
- B.I'll need to follow weight-bearing and brace limits longer than he did.
- C.I can return to deep squats next week, since the tear has been fixed now.
- D.My recovery should be faster than his because my meniscus was saved.
Show answer and explanation
Answer: B. I'll need to follow weight-bearing and brace limits longer than he did.
A meniscal repair must be protected while the tissue heals, so clients typically have weight-bearing, brace and flexion limits (often avoiding deep squatting) for weeks, whereas partial meniscectomy usually allows early full weight bearing. Recovery after repair is slower, although it preserves the meniscus long term. Brace use follows the surgeon's protocol, not pain level.
Question 5 · Metabolic Bone Disorders
A client who has received denosumab injections every 6 months for 5 years tells the nurse, "My bones are better now, so I'm going to skip the next shot and stop." Which response is most important?
- A.Stopping without a follow-up medication can cause rapid bone loss and spine fractures.
- B.You can stop safely if you keep taking calcium and vitamin D supplements.
- C.Stopping is fine, but you will need a dental cleaning before you stop the drug.
- D.That's reasonable, because denosumab stays bound to bone and protects it for years.
Show answer and explanation
Answer: A. Stopping without a follow-up medication can cause rapid bone loss and spine fractures.
The effect of denosumab wears off within months, and stopping it without transitioning to another agent, usually a bisphosphonate, causes rebound bone loss and multiple vertebral fractures, so the client should not stop without a plan from the prescriber. Unlike bisphosphonates, denosumab does not bind to bone, calcium and vitamin D alone do not prevent the rebound, and a dental cleaning is unrelated.
Question 6 · Degenerative Disorders: The Spine and Other Degenerative Conditions
A 64-year-old client is evaluated for osteoarthritis of the right hip. Which assessment findings should the nurse expect?
- A.Lateral hip pain that is worst when lying on that side at night
- B.Hot, red swelling of the hip with fever and refusal to move the leg
- C.Low back pain radiating below the knee with a positive straight-leg raise
- D.Groin pain with weight bearing and limited internal rotation of the hip
Show answer and explanation
Answer: D. Groin pain with weight bearing and limited internal rotation of the hip
Hip osteoarthritis classically causes groin or anterior thigh pain with activity, sometimes referred to the knee, and early loss of internal rotation. Lateral pain when lying on the side suggests greater trochanteric pain syndrome, radiating pain with a positive straight-leg raise suggests lumbar radiculopathy, and fever with a hot joint suggests septic arthritis.
Question 7 · Degenerative Disorders: The Spine and Other Degenerative Conditions
A client has a C5-C6 cervical disc herniation compressing the C6 nerve root. Which finding should the nurse expect?
- A.Numbness of the thumb and index finger with weak wrist extension
- B.Numbness of the middle finger with a decreased triceps reflex
- C.Numbness over the outer shoulder with weak shoulder abduction
- D.Numbness of the little finger with weak finger spreading and grip
Show answer and explanation
Answer: A. Numbness of the thumb and index finger with weak wrist extension
The C6 root supplies sensation to the thumb and index finger, powers wrist extension, and mediates the biceps and brachioradialis reflexes. Little finger numbness with weak intrinsic hand muscles fits C8, middle finger numbness with a reduced triceps reflex fits C7, and lateral shoulder numbness with weak abduction fits C5.
Question 8 · Orthopaedic Nursing Foundations: Assessment, Pain, Complications and Perioperative Care
A client with an unstable thoracolumbar burst fracture is on spinal precautions while awaiting surgical stabilization. The nurse needs to turn the client to inspect the skin on the back. Which technique is correct?
- A.Logroll with at least three staff, keeping the shoulders and hips aligned
- B.Turn the shoulders first, then bring the hips over once the trunk is turned
- C.Have the client grasp the side rail and pull over onto the unaffected side
- D.Raise the head of the bed to 45 degrees before turning the client to the side
Show answer and explanation
Answer: A. Logroll with at least three staff, keeping the shoulders and hips aligned
Logrolling with enough staff, one of whom directs the turn, moves the head, shoulders and pelvis as a single unit and prevents twisting or flexion at an unstable fracture. Pulling on the rail, raising the head of the bed and turning the shoulders before the hips all produce spinal rotation or flexion that can displace the fracture and injure the cord.
Question 9 · Sports Injuries
A 15-year-old dancer had a first-time lateral patellar dislocation that reduced when she straightened her knee. Radiographs show no fracture, and she is treated nonoperatively. Which teaching point is most accurate?
- A.Once the kneecap is back in place, it cannot dislocate again later
- B.The knee should be kept completely straight for 6 months to let it heal
- C.Quadriceps and hip strengthening helps prevent another dislocation
- D.A brace is needed only while sitting, since standing protects the knee
Show answer and explanation
Answer: C. Quadriceps and hip strengthening helps prevent another dislocation
Rehabilitation focusing on quadriceps (including the vastus medialis), hip abductor and core strength improves patellar tracking and lowers the recurrence risk, which is high in adolescents after a first dislocation. Prolonged immobilization causes stiffness and weakness. Recurrence is common, and bracing, if used, is for activity rather than for sitting.
Question 10 · Metabolic Bone Disorders
A 69-year-old client with osteoporosis and a healed vertebral compression fracture asks how to lift a laundry basket safely at home. Which technique should the nurse teach?
- A.Twist at the waist to swing the basket onto the counter in one smooth motion.
- B.Hold the basket close, keep the back straight and bend at the hips and knees.
- C.Bend forward at the waist with knees straight and lift the basket with both arms.
- D.Hold the basket at arm's length and round the back to reach it from the floor.
Show answer and explanation
Answer: B. Hold the basket close, keep the back straight and bend at the hips and knees.
Keeping the spine neutral, the load close to the body and bending at the hips and knees limits compressive force on the vertebral bodies. Forward flexion at the waist, twisting under load and holding objects at arm's length with a rounded back all increase the risk of a new vertebral compression fracture.

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