Orthopaedic Nurses Certification Exam

The ONC exam is a computer-based test delivered by Meazure Learning, either at a testing center or by live remote proctoring from your home or workplace. After your application is approved, you receive a notice to schedule and choose a date within your eligibility window.

Key Facts About the ONC Exam

ONC Questions by Condition Category

Degenerative Disorders and Orthopaedic Trauma together account for more than half of the exam, so osteoarthritis, joint replacement, spine conditions, fractures, casts, traction and external fixation deserve the largest share of your study time. Operative orthopaedics is not a separate category; surgical care is tested inside every condition.

ONC Questions by Nursing Task

Pain and complications together make up roughly half of the exam. Whatever the condition, expect to choose analgesic strategies, recognize early signs of a complication and decide what to report first.

The ONC exam is criterion-referenced: you are measured against a fixed passing standard, not against other candidates. ONCB sets the standard through an Angoff passing point study, in which experienced orthopaedic nurses judge how a minimally competent certified nurse would perform on each question. Because exam forms are statistically equated, the number of correct answers needed to pass can differ slightly between forms.

Only the 135 scored questions count, and you cannot tell which 15 are pilot questions, so give every question your best effort. There is no penalty for a wrong answer, so answer every question. Your results show pass or fail; any content-area feedback is for information only.

• Postoperative situations after joint replacement and spine surgery that ask for the first action or the finding to report
• Neurovascular and complication questions: compartment syndrome, venous thromboembolism, fat embolism, infection, dislocation
• Pain management choices, including multimodal analgesia, opioid safety and regional anesthesia
• Casts, splints, traction, external fixators and weight-bearing orders
• Medication teaching for osteoporosis, rheumatoid arthritis, gout and anticoagulation
• Assistive devices, positioning, precautions and safe mobility
• Pediatric conditions, tumors and neuromuscular disease as they affect orthopaedic care
• Nutrition for bone and wound healing, and emotional support during recovery

• Hold a current, full and unencumbered registered nurse license in the United States or its possessions, or an equivalent license from another country with an approved credential evaluation.
• Have two full years of experience practicing as a registered nurse.
• Have at least 1,000 hours of work experience as a registered nurse in orthopaedic nursing practice within the past three years, verified by a supervisor.
• A bachelor's degree in nursing is not required.
• Certification lasts five years. You recertify either by passing the exam again or by earning 75 contact hours of continuing education, at least 50 of them in orthopaedic nursing.

If you do not pass, you may retest after at least 90 days. Candidates may make up to four attempts within the eligibility period, and a retake discount applies automatically when you reapply. Check the current ONCB Candidate Handbook before you apply, because fees and policies are updated from time to time.