- Identity Check: Which ONC This Sheet Covers
- The Exam at a Glance
- The Two-Axis Blueprint: Conditions and Nursing Tasks
- Condition Categories: What to Memorize
- The Six Nursing Task Categories
- Eligibility, Fees, and Registration Mechanics
- Test-Day Rules and Retake Timing
- Pass Rate and Scoring: Reading the Numbers Carefully
- Renewal Rules in One Glance
- Mapping the Blueprint to Your Study Weeks
- Frequently Asked Questions
- The exam has 150 multiple-choice questions: 135 scored, 15 unscored pretest items, with three hours of testing time.
- The published raw passing threshold is 97 of 135 scored items; form-specific cut scores may differ slightly.
- Degenerative Disorders is the largest condition category at 51 items; Pain has the largest task range at 35-45.
- Eligibility requires two years of RN experience and at least 1,000 orthopaedic RN practice hours in the previous three years.
Identity Check: Which ONC This Sheet Covers
"ONC" is an acronym shared by several unrelated credentials, so start by confirming you are studying the right one. This cheat sheet covers Orthopaedic Nurse - Certified (ONC), the registered-nurse orthopaedic credential issued by the Orthopaedic Nurses Certification Board (ONCB). It is not the oncology nursing certification, and it is not the ONC-A credential. If you want the background on the name itself, see our explainers on what ONC is and what ONC stands for.
Everything below is drawn from the ONCB Candidate Handbook (January 2026 download, copyright 2025) and the current ONCB exam description, eligibility, fee, and recertification pages, which were checked in October 2026. Policies change, so verify fees and dates with ONCB before you apply.
The Exam at a Glance
| Item | What to Know |
|---|---|
| Format | 150 multiple-choice questions |
| Scored items | 135 |
| Unscored pretest items | 15 (indistinguishable from scored items) |
| Time | Three hours, with breaks taken within the exam clock |
| Raw passing threshold | 97 of 135 (published on the current Exam Description) |
| Delivery | Meazure Learning: computer testing center or live remote proctoring |
| Application system | ONCB LearningBuilder |
| Certification term | Five years, governed by ONCB's June 30 expiration rule |
Because you cannot tell which 15 items are unscored, treat every question as if it counts. The handbook describes Angoff standard setting and equating, which is why the cut score can differ slightly between exam forms even though 97/135 is the published figure. For a deeper look at scoring, read our guide to the ONC passing score.
The Two-Axis Blueprint: Conditions and Nursing Tasks
The most common misreading of the ONC outline is to treat it as 14 separate content buckets that add up to the exam. They do not. The detailed content outline has eight condition categories and six cross-cutting nursing tasks. These two axes intersect: a single question might be about a degenerative condition (the condition axis) while testing pain management or complication recognition (the task axis). Do not add the two sets of numbers together.
Our companion piece on all 14 ONC content areas goes deeper on each heading. Here is the compact version.
| Axis | Category | Published Allocation |
|---|---|---|
| Condition (Domain 1) | Degenerative Disorders | 51 items |
| Condition (Domain 2) | Orthopedic Trauma | 26 items |
| Condition (Domain 3) | Sports Injuries | 15 items |
| Condition (Domain 4) | Inflammatory Disorders | 11 items |
| Condition (Domain 5) | Metabolic Bone Disorders | 12 items |
| Condition (Domain 6) | Congenital/Pediatric Disorders | 7 items |
| Condition (Domain 7) | Musculoskeletal Tumors | 7 items |
| Condition (Domain 8) | Neuromuscular Disorders | 6 items |
| Task (Domain 9) | Self Care | 22-32 items |
| Task (Domain 10) | Pain | 35-45 items |
| Task (Domain 11) | Complications | 31-41 items |
| Task (Domain 12) | Activity | 15-25 items |
| Task (Domain 13) | Nutrition | 3-9 items |
| Task (Domain 14) | Psychosocial | 3-9 items |
Condition Categories: What to Memorize
Degenerative Disorders alone accounts for 51 of the 135 scored items, more than a third of the exam. Trauma adds 26. Together those two categories are 77 items, so they deserve the largest share of your content review. The remaining six categories are smaller but still matter, because you only need 97 correct and the small categories are where candidates often leave points behind.
Domain 1: Degenerative Disorders (51 items)
The single biggest block. Expect questions that pair a condition with the nursing task axis, such as pain management or complication surveillance after joint surgery.
- Osteoarthritis presentation, progression, and conservative versus surgical management
- Total joint arthroplasty care: preoperative teaching, positioning precautions, and postoperative monitoring
- Spinal degenerative conditions and the nursing care that follows spine procedures
- Recognition of early complications such as infection, thromboembolism, and neurovascular compromise
Domain 2: Orthopedic Trauma (26 items)
Fractures and their management, with an emphasis on assessment and what can go wrong.
- Fracture classification, healing, and immobilization methods including casts, traction, and external fixation
- Neurovascular assessment and recognition of compartment syndrome
- Fat embolism and other trauma-related complications
- Pin-site care and care of patients in traction
Domains 3-8: The Smaller Condition Categories
Individually small, collectively meaningful: Sports Injuries (15), Metabolic Bone Disorders (12), Inflammatory Disorders (11), Congenital/Pediatric Disorders (7), Musculoskeletal Tumors (7), and Neuromuscular Disorders (6).
- Sports Injuries: soft-tissue injury mechanisms, ligament and meniscal injury, rehabilitation principles
- Metabolic Bone Disorders: osteoporosis risk, screening, and fracture prevention
- Inflammatory Disorders: rheumatoid disease and its systemic nursing implications
- Congenital/Pediatric Disorders: pediatric-specific assessment and family teaching
- Musculoskeletal Tumors: recognition, treatment overview, and supportive care
- Neuromuscular Disorders: mobility, positioning, and safety concerns
The Six Nursing Task Categories
The task axis reflects what you do as an orthopaedic nurse regardless of diagnosis. Two of these categories carry especially wide ranges and reward clinical reasoning over recall.
Pain (35-45 items): the largest task range
Pain is the heaviest task category. Know multimodal analgesia principles, the assessment of pain in patients who cannot self-report, regional anesthesia considerations, and how to distinguish expected postoperative pain from pain that signals a complication. Questions often ask for the best next nursing action, so practice ranking responses rather than recalling single facts.
Complications (31-41 items)
This is where patient-safety judgment is tested. Be fluent in the warning signs and nursing response for infection, venous thromboembolism, compartment syndrome, neurovascular compromise, and fat embolism. When an answer choice involves escalating a deteriorating patient, it is rarely wrong to favor timely assessment and notification.
Self Care (22-32), Activity (15-25), Nutrition (3-9), Psychosocial (3-9)
- Self Care: patient and family teaching, assistive devices, home preparation, and discharge readiness
- Activity: weight-bearing status, mobility progression, and safe transfers
- Nutrition: nutritional support for bone and wound healing
- Psychosocial: coping, adherence, and support systems
Eligibility, Fees, and Registration Mechanics
Who qualifies
- Current, unrestricted RN licensure, or the board's specified foreign first-level nurse/equivalency route
- Two full years of RN experience
- At least 1,000 orthopaedic RN practice hours in the previous three years
- Immediate-supervisor verification, signed within 180 days of your application
- A BSN is not required
Our ONC requirements guide walks through documenting those hours and getting the supervisor verification right.
Fee structure
| Item | Eligible Full Member | Non-Member |
|---|---|---|
| Initial exam fee | US$325 | US$450 |
| Ordinary retake fee | US$275 | US$400 |
| CE renewal fee | US$275 | US$400 |
Member pricing applies to full NAON, AANP, NOVA, or CONA members. Student and associate memberships do not qualify, and the qualifying membership must remain active through the examination. See the full ONC certification cost breakdown for planning the total outlay.
Booking windows: do not conflate them
The handbook distinguishes the 366-day initial application eligibility period from the separate 90-day completion, scheduling, and refund provisions. They are different rules and should not be treated as one interchangeable booking window. Check the specifics before you pay, and see ONC exam dates and scheduling for how to plan around them.
Test-Day Rules and Retake Timing
- Closed-book exam: no calculators and no unauthorized reference materials
- Your valid government photo ID must match the name on your registration
- Breaks are allowed, but the clock keeps running
- Live remote proctoring is available through Meazure Learning, with U.S., Puerto Rico, and Canada delivery described in the handbook
- After an ordinary failed attempt, at least 90 days must pass before you can test again
- Retest for Success is a separate program with its own terms; do not assume ordinary retake rules apply to it
Pass Rate and Scoring: Reading the Numbers Carefully
The most-cited historical figure comes from ONCB's Official Summary of Certification Statistics 2014-2020: 58% in 2020, with 316 passes among 544 examinees. Be careful with it. It is not a 2026 figure, and it is not a verified first-attempt-only rate. Treat it as a rough historical signal that the exam is a genuine hurdle, not a prediction for your result.
Key Takeaway
A 97/135 raw threshold means you can miss up to 38 scored items and still pass, but the cut score can shift slightly by form. Aim for comfortable margin in the big categories rather than gambling on the small ones. For more context, see what the pass-rate data shows and how hard the exam really is.
Renewal Rules in One Glance
| Requirement | Current Rule |
|---|---|
| Certification term | Five years; June 30 expiration rule |
| Licensure | Current unrestricted RN license |
| Practice hours | 1,000 orthopaedic practice hours in the previous five years |
| Contact hours | 75 total, with at least 50 clinical orthopaedic hours and no more than 25 general nursing hours |
| CE renewal fee | US$275 eligible member / US$400 non-member |
| Alternative | Pass the reexamination before expiry |
The current 75-hour structure supersedes older 100-hour and 70+30 material that still circulates online. If a study forum quotes those older numbers, ignore them. Also note that the older January 2014 fee/AMP page is not the current authority for fees or pass rates.
Mapping the Blueprint to Your Study Weeks
Rather than a generic schedule, let the item counts drive the calendar: spend the most time where the exam spends the most items, and revisit the cross-cutting tasks every week because they apply to every condition. For a complete plan, see our ONC study guide.
Degenerative Disorders (51 items)
- Arthroplasty and spine care end to end
- Pair each condition with Pain and Complications questions
Orthopedic Trauma (26 items)
- Fracture management, traction, and neurovascular checks
- Compartment syndrome and fat embolism recognition
Smaller condition categories
- Sports, Metabolic Bone, Inflammatory, Pediatric, Tumors, Neuromuscular
Task axis consolidation
- Pain, Complications, Self Care, Activity
- Quick passes through Nutrition and Psychosocial
Timed practice
- Full-length sets under three-hour conditions, then targeted review of misses
When you reach the timed phase, work through realistic questions on our ONC practice test site and use the results to decide which category to revisit. If you want ongoing question practice between study blocks, the practice question bank is built for exactly that.
Frequently Asked Questions
The exam has 150 multiple-choice questions. Of those, 135 are scored and 15 are unscored pretest items. You cannot tell which are which, so answer every question carefully. You have three hours.
The current ONC Exam Description publishes a raw passing threshold of 97 out of 135 scored items. Because ONCB uses Angoff standard setting and equating, the cut score can differ slightly from one exam form to another.
No. There are eight condition categories and six cross-cutting nursing task categories, and the two axes intersect. A single question can touch both. Condition counts total 135; task figures are ranges and should not be added to the condition counts.
No. You need current unrestricted RN licensure (or the board's foreign-nurse equivalency route), two full years of RN experience, and at least 1,000 orthopaedic RN practice hours in the previous three years, plus supervisor verification signed within 180 days of applying.
For an ordinary failed attempt, at least 90 days must pass between examinations, and the ordinary retake fee is US$275 for eligible members or US$400 for non-members. The separate Retest for Success program has its own terms, so confirm those directly with ONCB.
Certification lasts five years under ONCB's June 30 expiration rule. You can renew with CE by holding unrestricted RN licensure, 1,000 orthopaedic practice hours in the previous five years, and 75 contact hours (at least 50 clinical orthopaedic, no more than 25 general nursing), or pass the reexamination before expiry. To weigh whether the credential is worth maintaining, see our ROI analysis and salary guide.