3.D Fibromyalgia
The nurse prepares a teaching plan for a client with fibromyalgia. Which area should the nurse include in this teaching? (Select all that apply.) A. Identification of resources and support systems B. The importance of adhering to an around-the-clock schedule of narcotic analgesics C. Examples of mild to moderate exercise D. Strategies for improving quality of sleep E. Nonpharmacologic methods of pain relief
A, C, D, E Rationale: Narcotics are not the treatment of choice for fibromyalgia pain because their side effects may lead to tolerance and dependence and worsen other fibromyalgia symptoms such as fatigue and activity intolerance. Nonpharmacologic methods of pain control, support systems, exercise, and improved sleep patterns are effective in improving symptoms and quality of life.
The nurse is providing education about ongoing care for a client with fibromyalgia. Which information should the nurse include? (Select all that apply.) A. Strategies for stress reduction B. The use of cold therapy C. Use of prescription medications D. Follow-up care E. Information on gymnasium memberships
A, C, D, E Rationale: The nurse should teach the client about reducing stress to assist in managing the symptoms of fibromyalgia. The nurse should teach the client about the importance of keeping follow-up appointments with healthcare providers. The nurse should teach the client about taking medications as prescribed. Cold therapy does not improve fibromyalgia symptoms. Aquatic therapy is preferred over membership at a gym where aerobic exercises are offered.
A nurse is providing education about fibromyalgia to a group of new nurses. When discussing the pathophysiology of this disorder, which system of the body should the nurse address? (Select all that apply.) A. The autonomic nervous system B. The renal system C. The somatic peripheral nervous system D. The cardiac system E. The endocrine system
A, C, E Rationale: The pathophysiology of fibromyalgia involves the autonomic nervous system, somatic peripheral nervous system, and endocrine system. The pathophysiology of fibromyalgia does not involve the renal or cardiac systems.
A client with fibromyalgia is prescribed a serotoninnorepinephrine reuptake inhibitor. Which side effect of the medication should the nurse include when teaching the client about this medication? (Select all that apply.) A. Nausea B. Diarrhea C. Increased sleepiness D. Dizziness E. Dry mouth
A, D, E Rationale: Common side effects of selective serotonin-norepinephrine reuptake inhibitors include dry mouth, nausea, and dizziness; constipation (not diarrhea) and insomnia (not increased sleepiness) are also common side effects.
When planning care for a client affected by fibromyalgia, the nurse addresses the potential problem of activity intolerance. Which should the nurse recommend to the client to most effectively address this problem? A. A program of regular, mild to moderate exercise B. Referral to physical therapy for an assistive device C. Daily meditation and guided imagery D. Nonsteroidal anti-inflammatory drugs (NSAIDs) taken on a regular schedule
A. A program of regular, mild to moderate exercise Rationale: Meditation and guided imagery can reduce anxiety. NSAIDs address the problem of pain. Assistive devices do not increase conditioning or activity tolerance in the absence of injury or neurologic deficits. Regular, mild to moderate exercise improves conditioning and activity tolerance.
During a staff in-service, an attendee asks if there are any other disease processes that commonly occur with fibromyalgia. Which condition should the nurse list as a comorbidity with this health problem? A. Depression B. Cardiovascular disease C. Peptic ulcer disease D. Lupus
A. Depression Rationale: Depression is often a comorbidity with fibromyalgia that requires treatment. Peptic ulcer disease, cardiovascular disease, and lupus are not.
A client with fibromyalgia asks why a selective serotonin and norepinephrine reuptake inhibitor is prescribed for the health problem. Which should the nurse explain as the rationale for this medication? A. Increase levels of dopamine and serotonin B. Relax the client and promote sleep C. Reduce neuropathic pain D. Decrease joint pain and swelling
A. Increase levels of dopamine and serotonin Rationale: A selective serotonin and norepinephrine reuptake inhibitor (SSNRI) is prescribed to a client with fibromyalgia to increase serotonin and norepinephrine levels. This medication is not prescribed to reduce neuropathic pain, decrease swelling of joints, or relax the client to promote sleep. A gamma-aminobutyric acid (GABA) analog is prescribed to reduce neuropathic pain. Nonsteroidal anti-inflammatory drugs are prescribed to decrease swelling of joints. A selective serotonin reuptake inhibitor (SSRI) is prescribed to promote sleep.
The nurse reviews sleep hygiene practices for a client with fibromyalgia. Which client statement indicates that further teaching is required? A. "I take a nap every afternoon." B. "I listen to music or read before I go to bed." C. "My bedroom is restful and free of irritations." D. "I make sure to go to bed and wake up at the same time each day."
A. "I take a nap every afternoon." Rationale: Good sleep hygiene includes going to bed and awakening at the same time each day, clearing the bedroom of irritations, and engaging in quiet, calming activities before bed. Daytime naps should be avoided because they disrupt nighttime sleep.
The nurse creates a care plan for a client with fibromyalgia. Which primary goal of treatment should the nurse include in the plan of care? (Select all that apply.) A. Improving verbal communication B. Increasing restorative sleep C. Improving physical function D. Ensuring an effective breathing pattern E. Reducing pain
B, C, E Rationale: The primary goals of treatment for a client with fibromyalgia include reducing pain, increasing restorative sleep, and improving physical function. The client with fibromyalgia does not have trouble communicating verbally or difficulty breathing.
A client with fibromyalgia asks which type of exercise would be most effective. Which response should the nurse make to this client? A. Isometric strength training B. Aquatic therapy C. Stretching exercises D. Gym-based program
B. Aquatic therapy Rationale: A recent study concluded that an aquatic program is more effective for reducing fibromyalgia symptoms than a gym-based program, isometric strength training, or stretching exercises. Water prevents stress on the joints.
Which area should the nurse include when conducting the focused physical examination portion of the nursing assessment for a client with fibromyalgia? A. Duration of pain B. Palpation of tenderness points C. Pattern of fatigue D. Symptom severity scale
B. Palpation of tenderness points Rationale: Palpation is an element of the physical examination portion of the nursing assessment. Duration of pain, fatigue pattern, and symptom severity scale are elements of the health history portion of the nursing assessment.
The nurse discusses the treatment of fibromyalgia with a group of staff nurses. Which information about the treatment of this disorder should the nurse include? A. Fibromyalgia treatment can be provided only in a hospital or outpatient setting. B. The treatment that works for one client may not work for another. C. Treatment only includes analgesic medications. D. Fibromyalgia treatment follows an algorithm that is used for every client.
B. The treatment that works for one client may not work for another. Rationale: The difficulty in treating fibromyalgia is that what works for one client may not work for another. Clients are encouraged to keep trying different therapies until they find what works for them. There is no one algorithm that is used for all clients. Fibromyalgia is a chronic condition, so clients provide self-care and treatment in their homes. Several classes of medications as well as complementary therapies are utilized to treat the disease.
Which occurrence should the nurse expect to assess as a precipitating factor for the symptoms of fibromyalgia in a client? A. Bacterial infection of affected joint B. Viral illness C. Septicemia with group A streptococcus infection D. Recent injury to joint or bone
B. Viral illness Rationale: The precise etiology and precipitating factors for fibromyalgia are not known; however, there is no correlation between strep A infection, mechanical injury to bones, or local bacterial infections and the onset of symptoms. Affected individuals often report viral-like illness prior to the onset of symptoms.
A client suspected of having fibromyalgia asks why diagnostic tests are being prescribed. Which response should the nurse make to this client? A. "All clients with this diagnosis have these tests." B. "The healthcare provider is trying to rule out other causes of your symptoms." C. "The healthcare provider is just trying to determine your general state of health." D. "Fibromyalgia can be diagnosed with blood and hormone testing."
B. "The healthcare provider is trying to rule out other causes of your symptoms." Rationale: Blood tests and scans do come back negative in clients with fibromyalgia. The healthcare provider needs to rule out conditions that might be causing the client's pain and other symptoms. There are no specific tests that all clients with fibromyalgia must receive. Although certain lab tests might give information about the client's general state of health, this is not the reason for testing prior to the diagnosis of fibromyalgia.
A client with fibromyalgia is interested in nonpharmacologic therapies to treat the disease. Which therapy should the nurse suggest that the client try? A. Herbal therapy B. T'ai chi C. Yoga D. Long-distance running
B. T'ai chi Rationale: T'ai chi has been shown to improve fibromyalgia symptoms, physical function, quality of sleep, self-efficacy, and mobility. Yoga and herbal therapy have not been shown to positively affect fibromyalgia. Long-distance running is a high-level aerobic exercise. Low or moderate exercise is preferred.
The nurse discusses fibromyalgia with a group of community members during a health fair. Which characteristic of pain should the nurse explain to this group? (Select all that apply.) A. Occurs mainly in fingers and toes B. Often described as superficial or achy C. Increased response to painful stimuli D. Is not the result of inflammation or damage E. Sensitivity to stimuli that are not normally painful
C, D, E Rationale: The pain in fibromyalgia presents as an increased response to painful stimuli and sensitivity to stimuli (heat, cold, or pressure) that are not normally painful. It occurs above and below the waist on both the left and right sides of the body. The pain is not the result of inflammation or tissue damage but results from the central amplification of pain signals. The pain is often described as deep, stabbing, gnawing, or burning.
During hand-off communication, the charge nurse is asked questions about a client's diagnosis of fibromyalgia. Which disease process should the nurse explain that closely resembles this disorder? A. Osteoarthritis B. Sjgren syndrome C. Chronic fatigue syndrome D. Muscular dystrophy
C. Chronic fatigue syndrome Rationale: Fibromyalgia closely resembles chronic fatigue syndrome with the exception of the musculoskeletal pain typically associated with fibromyalgia. Fibromyalgia does not closely resemble Sjögren syndrome, muscular dystrophy, or osteoarthritis.
While conducting a class on health promotion and disease prevention, a participant asks how to prevent fibromyalgia. Which action should the nurse explain as one that reduces the risk of developing the disorder? A. "Follow a vegetarian diet." B. "Take a daily vitamin capsule." C. "Keep your weight down, exercise, and get frequent checkups." D. "Start taking ginkgo biloba."
C. "Keep your weight down, exercise, and get frequent checkups." Rationale: Maintaining a healthy lifestyle is the best way to reduce the risk of developing fibromyalgia. Vitamins, following a vegetarian diet, and ginkgo have not been shown to reduce the risk of developing fibromyalgia.
A client with fibromyalgia stopped participating in an aerobic exercise program because the pain and fatigue became worse. Which response should the nurse make to this client? A. "You are right to quit; exercise should not make your pain and fatigue worse." B. "Exercise is important: No pain, no gain." C. "I exercise three times a week; it makes me feel so much better." D. "You may see a short-term increase in pain and fatigue; these should decrease over time."
D. "You may see a short-term increase in pain and fatigue; these should decrease over time." Rationale: A short-term increase in pain and fatigue is normal and expected; this should decrease over time as the client develops better tolerance of activity. Exercise improves oxygen uptake and decreases pain and fatigue; the client needs to continue.
During a home visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this client? A. "You are fatigued because you stay up too late at night." B. "Maybe you should get a new mattress or pillow." C. "Have you been worried about anything in particular lately?" D. "Your fatigue is most likely the result of sleep disturbances, particularly insomnia."
D. "Your fatigue is most likely the result of sleep disturbances, particularly insomnia." Rationale: Fatigue in fibromyalgia is most likely caused by sleep disturbances such as insomnia, poor quality of sleep, early morning awakening, or nonrestorative sleep. It is not caused by worry, staying up too late, or an old mattress or pillow.
