Exam (elaborations)

ONC General Practice Exam 2024 with 100% correct answers

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ONC General Practice E

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ONC General Practice E

To establish the diagnosis of osteoporosis, a patient's primary care provider orders a DEXA scan (dual energy x-ray absorptiometry). The patient asks the nurse, "How will the test show if I have osteoporosis?" The nurse's response should be based on knowledge that which of the following accurately ...

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onc general practice exam

Institution ONC General Practice E
Course ONC General Practice E

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ONC General Practice Exam

To establish the diagnosis of osteoporosis, a patient's primary care provider orders a DEXA scan (dual
energy x-ray absorptiometry). The patient asks the nurse, "How will the test show if I have
osteoporosis?" The nurse's response should be based on knowledge that which of the following
accurately describes this procedure?

a. The patient will be given a radioactive isotope several hours before the scan, and its uptake into the
patient's bones will be measured.

b. The patient's bone density will be compared to the reference range of healthy young adults.

c. The amount of calcium in the patient's bones will be compared to the patient's serum values of
osteocalcin and alkaline phosphatase.

d. The patient's peak bone mass will be measured by comparing the ratio of cortical to cancellous bone
in her distal forearm. correct answersb. The patient's bone density will be compared to the reference
range of healthy young adults.

Rationale: DEXA compares a patient's bone density in the hip and spine to that of a mean young adult
normal reference range (known as the T-score). DEXA is a noninvasive diagnostic that does not require
the use of a radioisotope. There are also no associated laboratory studies, and assessment of the distal
forearm is not completed as part of DEXA scanning.

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 96

A patient is newly diagnosed with osteoporosis and risedronate sodium (Actonel®) is prescribed. The
nurse should give which of these instructions about the drug to the patient?

a. "Take the Actonel at night immediately before you got to bed."

b. "Take a multivitamin that contains 400 IU of vitamin D every day to promote absorption of the
Actonel."

c. "After taking Actonel, remain in an upright position for at least 30 minutes."

d. "Before taking Actonel, eat a small amount of food to prevent stomach irritation." correct answersc.
"After taking Actonel, remain in an upright position for at least 30 minutes."

,Rationale: Bisphosphonates such as Actonel need to be taken on an empty stomach at least 30 minutes
before breakfast, and the patient should remain in an upright position.

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 380, Table 14-1

A patient is suspected of having osteomalacia and is undergoing diagnostic testing. The patient
understands this disease is caused by inadequate intake of vitamin D, but asks the nurse what other
factors may have contributed to development of this condition. Based on the patient's history, the nurse
should identify which of the following as a risk factor for decreased synthesis of vitamin D?

a. Having renal disease

b. Having light skin

c. Living at low altitude

d. Living on a farm correct answersa. Having renal disease

Rationale: Adults affected by chronic diseases of the liver, kidney, and small intestine have decreased
bone mineralization related to vitamin D deficiency. Dark skin does not synthesize vitamin D as easily as
fair skin. Persons who live at high altitudes also do not synthesize vitamin D as readily as those living at
lower altitudes. Living on a farm has no direct impact, but living in long-term care facilities with limited
exposure to sunlight can affect vitamin D synthesis.

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 383

The mother of a 50-year-old patient has been diagnosed with osteoporosis. The patient asks about her
own risk for the disease. Based on discussion with the patient about her history and lifestyle, the nurse
should identify which of the following as a risk factor for osteoporosis?

a. She is 10 pounds overweight.

b. She smokes one pack of cigarettes per day.

c. She drinks two cups of coffee every morning.

d. She never had children. correct answersb. She smokes one pack of cigarettes per day.

Rationale: Smoking has been shown to increase the incidence of osteoporosis by influencing the onset of
menopause and the lowering of bone mineral density. Being overweight does not contribute to

, osteoporosis; two cups of coffee a day is moderate intake of caffeine and not considered a risk factor.
Never having had children is only a factor if it contributes to early menopause.

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 379

A close friend of the nurse has experienced intermittent swelling and pain in the joints of the hands,
feet, and knees over the past year. The nurse suspects the friend has rheumatoid arthritis (RA) and
encourages evaluation by a healthcare provider. What other, early symptom should lead the nurse to
suspect RA?

a. Hip pain

b. Photosensitivity

c. Weight gain

d. Fatigue correct answersd. Fatigue

Rationale: Fatigue, lethargy, and weight loss are common early symptoms of RA.

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 341

After an acute episode of painful swelling of multiple joints accompanied by disabling morning stiffness,
a patient is diagnosed with psoriatic arthritis. The nurse should recognize that blood test results are likely
to include which of the following?

a. Erythrocyte sedimentation rate 20 mm/hr

b. Rheumatoid factor 12 IU/ml

c. Serum uric acid 7.6 mg/dL

d. White blood cell count 7000 cells/microliter correct answersc. Serum uric acid 7.6 mg/dL

Rationale: Hyperuricemia (greater than 7 mg/dL in men, 6 mg/dL in women) is possible in psoriasis
because of rapid cell turnover. While ESR may be elevated in psoriatic arthritis during acute
inflammation, a value of 20 mm/hr is normal (0-22 for men, 0-29 for women). Less than 14 IU/ml is
considered a normal RF value, as is 7000 white cells/microliter (normal 4000-11,000).

Reference: Core Curriculum for Orthopaedic Nursing (7th ed.), 2013, p. 363

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