ONC study guide
ONC · Work through your exam, one topic at a time.
The Orthopaedic Nurse Certified (ONC) credential is a specialty nursing certification offered by the Orthopaedic Nurses Certification Board (ONCB). ONCB describes ONC as a program built "for nurses by nurses based on analysis of real orthopaedic nurses' practice," and states that the credential is recognized by colleagues and employers as a mark of excellence showing that a nurse is educated, engaged, and committed to delivering high-quality care to orthopaedic patients. The ONC study guide has 8 sections and about 2,416 words.
01Assessment and Diagnostic Evaluation of the Orthopaedic Patient
History → inspection → palpation → range of motion → strength → neurovascular status → imaging and labs. Mechanism of injury predicts fracture pattern and associated injuries.
330 words, about 2 min02Musculoskeletal Trauma and Fracture Management
A complete description includes open versus closed, bone and location, pattern (transverse, oblique, spiral, comminuted, segmental, avulsion, impacted), displacement, angulation, shortening, rotation, and joint involvement. Spiral patterns reflect torsional force; transverse reflects direct blow or bending; comminution reflects high energy.
291 words, about 1 min03Degenerative, Inflammatory, and Metabolic Musculoskeletal Conditions
Osteoarthritis is mechanical: weight-bearing joints, pain worse with use and better with rest, morning stiffness under 30 minutes, Heberden (DIP) and Bouchard (PIP) nodes, asymmetric, no systemic features; radiographs show joint-space narrowing, osteophytes, subchondral sclerosis, and cysts. Rheumatoid arthritis is inflammatory and systemic: symmetric small-joint involvement (MCP, PIP, wrists), morning stiffness over one hour, improvement with use, ulnar deviation, swan-neck and boutonnière deformities, nodules, fatigue, and extra-articular disease.
302 words, about 2 min04Spine, Neurologic, and Neurovascular Considerations
Injury level is defined by the lowest intact segment; ASIA scoring documents motor and sensory level and separates complete from incomplete injury. Spinal shock is the transient loss of reflexes with flaccid paralysis below the lesion.
309 words, about 2 min05Pediatric and Adolescent Orthopaedic Care
Salter–Harris classification: I slipped (physis only), II above (physis plus metaphyseal fragment, most common), III lower (physis plus epiphysis), IV through (metaphysis, physis, epiphysis), V crush (often radiographically silent). Higher grades carry greater growth-arrest risk.
285 words, about 1 min06Perioperative, Procedural, and Traction/Cast Care
Informed consent, correct-site verification with marking, and a formal time-out before incision. Prophylactic antibiotics are given within 60 minutes of incision (within 120 minutes for vancomycin or fluoroquinolones).
287 words, about 1 min07Complications, Pain Management, and Patient Safety
The classic six Ps: pain out of proportion, pain with passive stretch, pressure (tense compartment), paresthesia, pallor, and pulselessness - but pulselessness and paralysis are late and unreliable. The earliest sensitive sign is pain with passive stretch of the compartment muscles.
299 words, about 1 min08Professional Practice, Rehabilitation, and Patient Education
Rehabilitation begins on admission: positioning, early mobilization, range of motion, then progressive strengthening, then functional training and gait. Weight-bearing orders must be followed exactly: non-weight-bearing, toe-touch, partial, weight-bearing as tolerated, full.
313 words, about 2 min