My Orthopedic Nurse Certification Exam (ONC) Heartbreaker

[TheCommuter, BSN, RN]

I failed the orthopedic certification exam this morning. It was heartbreaking because I missed the minimum cut by seven questions. I answered 90 questions correctly and needed to answer 97 questions correctly in order to pass. Anyhow, I plan to retake it during the early part of next year after some self study.

I should mention that I took the exam cold with no prior preparation. Why would I do such a thing, you might ask? It is because I made a scheduling mistake and could not reschedule. Therefore, I was faced with the option of either taking the test or forfeiting the fees. I figured I would take the exam and see what it was all about rather than forfeiting totally.

I should also mention that my orthopedic experience is all indirect: I deal with TKAs, THAs, amputations, fractures, trauma, MVAs, ORIFs, braces, orthotics, gait training, laminectomies, kyphoplasties, anticoagulation, rotator cuff repairs, cauda equina syndrome, pin site care, incisional care, and other common orthopedic issues as a post-acute rehabilitation nurse.

For inquiring minds who want to know, the test was about one-third medications. You had to possess knowledge regarding epidural blocks, anesthesia, oncologic issues involving the bone, orthotics, braces, casts, splints, halos, and so forth. This was in addition to your garden variety orthopedic disease processes such as OA, RA, gout, lupus, and osteoporosis.

Feel free to ask any questions while my memory is still fresh.

[Red Kryptonite]

Hey, if you took it cold and only missed by 7 questions, let that boost your confidence for next time. When you actually study, you'll kill it.

[~PedsRN~, BSN, RN]

I go back and forth with this exam.... I'm an inpatient peds nurse on an ortho/trauma floor. So I see a lot of ortho, but for the most part it's spinal fusions, femurs, tibfibs, a few arms and of course the old broken wing (elbows) that come in and go home same day. We see a few hips, and I do have experience with external fixators and halos. I know traction, braces, and casting. But my knowledge obviously is going to be heavy on the things that kids deal with. Will I even scratch the surface?

[SHGR, MSN, RN, CNS]

There is a test blueprint available online (almost every nursing certification exam has one freely available; I feel that those that do not are suspect).

The ortho one is available at

ONC® Exam Description » Orthopaedic Nursing Certification Board Orthopaedic Nursing Certification Board

So if you see areas in which you are less experienced, you can study those more.

[meanmaryjean, DNP, RN]

Hey TheCommuter,

I know you're a WGU student - so think of it as your pre-assessment!

You got this!

[tokmom, BSN, RN]

Sorry to hear this. Failing anything sucks. If your certification test is anything like the med/surg cert test, some questions are rather odd!

I don't blame you for taking it cold. If you can't reschedule ( I know the AMSN test was very sticky on dates) I would have done exactly what you did. Wing it and see what it's about.

[TheCommuter, BSN, RN]

But my knowledge obviously is going to be heavy on the things that kids deal with. Will I even scratch the surface?

On a scale of 1 to 10, I would say this certification exam has a level of difficulty of about a 6. It is not easy but not extremely difficult, and I feel you could probably pass it with about four to six weeks of self-study.

[TheCommuter, BSN, RN]

If your certification test is anything like the med/surg cert test, some questions are rather odd!

I received a question about the Female Athlete Triad, which I thought was somewhat bizarre although it does have orthopedic implications.

[fromtheseaRN, BSN, RN]

I'll second what was said above, that's a great score for walking in cold.

I'm scheduled to take mine at the end of January. I work inpatient ortho, so our patients are elective joints and traumas, and I also worked in the OR on mostly ortho cases. I have the practice test disc that you can buy from NAON, and the areas I struggle in are the ones you see in clinic and not in the hospital... your spondyloarthropathies, gout, etc. Not seeing these things in practice make them hard to remember for me. Aside from the female athlete triad, any other bizarre topics you remember? Thanks for the help!

[TheCommuter, BSN, RN]

Aside from the female athlete triad, any other bizarre topics you remember? Thanks for the help!

Although I took the exam more than a month ago and am barely seeing your question, I do recall a general question about Metoprolol (Lopressor) that caught me off guard. I was wondering why the exam had a question about a Beta Blocker, but I suppose having a thorough familiarity with Metoprolol is important in most areas of nursing practice.