Orthopaedic Nurses Certification

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The Orthopaedic Nurses Certification (ONC) examination was created by the Orthopaedic Nursing Certification Board (ONCB), which was founded in 1986 by members of the National Association of Orthopaedic Nurses (NAON) to create a certification program to recognize expertise in orthopaedic nursing. The ONCB continues to maintain and administer the examination.[1]

The ONCB regularly conducts role delineation studies to determine which skills and competencies are most crucial in the practice of orthopaedic nursing. It regularly revises the content of the ONC examination to ensure it matches the most up-to-date demands of the profession of orthopaedic nursing.[2]

Function of the Test

Orthopaedic Nurse Study Guide

The ONC certification is designed to recognize expertise and continued professional development in the field of orthopaedic nursing. ONC Certification is not typically required as a condition of employment, but nurses who obtain the certification may find it beneficial in the advancement of their careers.[3]

The NAON states that as the baby boomer population of the United States continues to age, musculoskeletal diseases are becoming more prevalent. Simultaneously, ongoing advances in musculoskeletal care require orthopaedic nurses to know more information and practice more skills and techniques than ever before. In the face of these challenges, ONC certification thus helps to ensure the proficiency and ongoing professional development of orthopaedic nurses.[2]

Candidates who wish to apply to take the examination must have two full years of experience practicing as an RN. In addition, candidates must have a minimum of 1,000 hours of work experience as an RN in orthopaedic nursing practice within the past three years. Alternative qualifications apply for international candidates not licensed to practice in the United States.[4]

In a typical year, about 1,000 nurses take the ONC examination, and of those, about 78% pass. Further statistics are available in the Scoring section below.

Test Administration

Orthopaedic Nurse Flashcards

The ONC Exam is offered year-round by more than 170 AMP test centers across the United States.[5] After successfully submitting an application to take the ONC exam, candidates have 90 days in which to schedule and take the examination.[5]

The fee for taking the ONC exam is $290 for members of the National Association of Orthopaedic Nurses (NAON) and $405 for non-members. An addition $25 fee is charged to candidates who apply using the paper application rather than applying online.[6] If a group of five or more nurses register for the exam together using the paper application form, each will receive a $30 discount, and the $25 fee for applying via paper will be waived. Group rates are not available via the online application.[6]

Unsuccessful candidates who wish to re-take the examination may do so at least 90 days after the date of the previous exam. Such candidates may complete a special retest application provided by AMP which gives a $50 discount on the exam fee.[5]

Candidates who require accommodations for a disability may complete the Request for Special Examination Accommodations and Documentation of Disability forms included in the ONC exam handbook. Standard accommodations include extended testing time (time and a half) and a reduced distraction environment, but other appropriate accommodations may be requested in writing.[7]

Test Format

Sections of the ONC Test
ONC Test Subject Areas Percentage
Degenerative Disorders 37%
Orthopedic Trauma 29%
Sports Injuries 7%
Inflammatory Disorders 9%
Metabolic Bone Disorders 6%
Pediatric/Congenital 4%
Musculoskeletal Tumors 4%
Neuromuscular 4%
Total 100%

Test Environment

For admission, each candidate must bring at least two forms of ID. One must be a government issued, photo ID containing a signature. Once signed in and in the testing room, there are no personal items allowed. Wallets and keys are the only personal items admitted into the testing room. All other personal items must be locked in a locker provided by the testing center. The exam takes place on the computer, and once it begins, the time limit of three hours begins as well.[8]

Test Structure

The Orthopaedic Nurses Certification Exam deals with eight major conditions: Degenerative Disorders; Orthopedic Trauma; Sports Injuries; Inflammatory Disorders; Metabolic Bone Disorders; Pediatric/Congenital; Musculoskeletal Tumors; and Neuromuscular. Along with these conditions, the test also deals with five major roles of an Orthopaedic Nurse: Clinician/Practitioner, Educator, Manager, Consultant, and Researcher. There are 150 questions, including 15 unscored, pretest questions. The time allotted to complete the exam is three hours.[9]

Test Content

  • Sample ONC Practice Questions
  1. A patient with psoriasis develops marked edema of the fingers and toes (dactylitis). What does this probably indicate?
    A. Infection
    B. Psoriatic arthritis
    C. Circulatory impairment
    D. Allergic response to psoriasis medications
  2. A patient with a hip spica cast complains of feeling severely claustrophobic. Which intervention may be most effective?
    A. Instruct the patient in relaxation techniques
    B. Cut a window over the patient's abdomen
    C. Request an order for anti-anxiety medication
    D. Position the patient flat in bed
  3. The use of which of the following medications puts patients at risk for defective vitamin D metabolism and osteomalacia?
    A. Phenytoin
    B. Hydrochlorothiazide
    C. Metformin
    D. Acetaminophen
  4. A child with polyarticular juvenile idiopathic/rheumatoid arthritis is non-responsive to other drugs and is going to receive a TNF blocking agent (infliximab). What test must be completed prior to administration of the medication?
    A. TB test
    B. Coagulation profile
    C. HIV test
    D. Stool for occult blood
  5. A patient with recurrent gout is at increased risk for
    A. nephrolithiasis
    B. cholelithiasis
    C. pancreatitis
    D. rheumatoid arthritis
  6. An infant is born with polydactyly of the right foot; however, there is no bony involvement. The most appropriate treatment at this time would be
    A. surgery to remove the extra digit
    B. no treatment at this time
    C. tie off the extra digit with a silk suture or vascular clip
    D. clip off the extra digit as there is no bony involvement
  7. Quantitative computed tomography is primarily used to measure bone density of which part of the skeleton?
    A. Hip
    B. Vertebrae (spine)
    C. Arms and legs
    D. Heel and forearm
  8. A patient who pitches on a baseball team complains of numbness in the thumb and first two fingers of his throwing hand on arising in the morning, although strength and grip remain intact. Which of the following initial treatments is most important?
    A. Surgeical repair
    B. Splint
    C. Corticosteroid injection
    D. Nonsteroidal anti-inflammatory drugs
  9. A patient with a mild cervical disk injury has been prescribed a soft cervical collar. To select the appropriate size, the nurse must take which of the following measurements?
    A. Neck circumference and measurement from the sternal notch to the mandible
    B. Neck circumference only
    C. Neck circumference and measurement from the shoulder to the base of the ear
    D. Neck circumference and measurement of the chin to the base of the ear

More free Orthopaedic Nurse practice test questions.


The ONC exam is a pass/fail examination in which the candidate's raw score is compared to a pass/fail cutoff point. This means that guessing is not penalized; incorrect answers count the same as omitted answers. Anyone who scores above the cutoff is considered at least minimally qualified to pass the exam and achieve certification, while people who score below it are not qualified to pass.[7]

A panel of experts assesses every individual question on the examination to estimate what percent of minimally-qualified candidates would answer each question correctly. All of these predictions are added up and averaged across the full exam to determine the final cutoff score for that version of the examination. Because different versions of the examination contain different questions of varying levels of difficulty, the raw cutoff score changes from version to version of the exam.[7]

Historical pass rates are available in the table below:

ONC exam pass rates[10]
Year Examinees Pass rate
2013 726 68.3%
2012 1368 72.2%
2011 1086 86.5%
2010 1151 86.4%
Average 1083 78.4%

Answers to Sample Questions

1;D 2;B 3;A 4;A 5;A 6;C 7;B 8;B 9;A


  1. ^ NAON August 3 2014
  2. ^ a b National Association of Orthopaedic Nurses - Position Statement - Orthopaedic Certification for Nurses August 3 2014
  3. ^ ONC® Certification
  4. ^ ONC® Exam Eligibility
  5. ^ a b c ONC® Application / Testing Sites August 3 2014
  6. ^ a b ONC® Exam Fees August 3 2014
  7. ^ a b c Orthopaedic Nurses Certification Board Candidate Handbook 2014 August 3 2014
  8. ^ ONCB FAQ 21 August 2014
  9. ^ Candidate Handbook 21 August 2014
  10. ^ ONCB Certification Statistics August 3 2014