Fibromyalgia

The nurse reviews sleep hygiene practices for a client with fibromyalgia. Which client statement indicates that further teaching is required? A) "I make sure to go to bed and wake up at the same time each day." B) "I listen to music or read before I go to bed." C) "I take a nap every afternoon." D) "My bedroom is restful and free of irritations."

C) "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

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? SATA A) The cardiac system B) The renal system C) The endocrine system D) The somatic peripheral nervous system E) The autonomic nervous system

C, D, 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.

The nurse is discussing goals to relieve pain and fatigue with a client newly diagnosed with fibromyalgia. Which goal statement would be realistic for this client to achieve within 30 days? *Note from Mary: This is kind of a shit question* A) Cook dinner five nights a week B) Join an exercise group to meet five nights a week C) Walk her son to school daily D) Get a job outside the home

A) Cook dinner five nights a week Rationale: Fibromyalgia reduces the client's energy. The client might set as an initial goal to be able to perform daily tasks for the family such as cooking and doing the laundry. Walking her son to school daily is a bit ambitious to start, as are joining an exercise group and getting a job outside the home.

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) Lupus C) Cardiovascular disease D) Peptic ulcer disease

A) Depression Rationale: Depression is often a comorbidity with fibromyalgia that requires treatment. Peptic ulcer disease, cardiovascular disease, and lupus are not.

Which is a characteristic of fibromyalgia? A) Difficult to treat B) Definite as to cause C) Easy to prevent D) Brief in its effects

A) Difficult to treat Rationale: Fibromyalgia is difficult to treat. a combination of pharmacologic and nonpharmacologic therapies is needed to control pain and fatigue. Individuals with fibromyalgia are often referred to a rheumatologist for specialty care. No exact cause for fibromyalgia is known, and it may present without precipitating factors. No means of preventing fibromyalgia is known, and it may only be diagnosed if the pain has lasted at least 3 months.

A 13-year-old female client is diagnosed with juvenile primary fibromyalgia syndrome. What should the nurse expect regarding this client? A) The nurse will treat the client in much the same way as an adult with fibromyalgia B) Chronic fatigue can be ruled out as a likely clinical manifestation C) The client's pain will likely have lasted no more than 3 months D) The client's WPI score will be no greater than 7.

A) The nurse will treat the client in much the same way as an adult with fibromyalgia. Rationale: JPFS is most commonly diagnosed in girls between the ages of 13 and 15. Triggers and symptoms of JPFS are similar to those of adult fibromyalgia, and so the nurse's interventions with this client are likely to pertain to pain management, fatigue reduction, and increased activity tolerance, just as they would for an adult patient. Because this client's symptoms are likely to be the same as those of an adult with fibromyalgia, the client is likely to experience chronic fatigue, pain lasting more than 3 months, and a WPI score of at least 7.

The nurse prepares a teaching plan for a client with fibromyalgia. Which area should the nurse include in this teaching? SATA A) Strategies for improving quality of sleep B) Examples of mild to moderate exercise C) The importance of adhering to an around-the-clock schedule of narcotic analgesics D) Identification of resources and support systems E) Nonpharmacologic methods of pain relief

A, B, 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 caring for a client who is diagnosed with fibromyalgia. Based on this diagnosis, which clinical manifestations might the nurse anticipate for this client? SATA A) Weakness B) Exhaustion C) Pain in the calves of the legs D) Nausea and vomiting E) Anxiety

A, B, E Weakness Exhaustion Anxiety Rationale: The client with fibromyalgia may experience weakness from fatigue; exhaustion from nonrestorative sleep, waking up too early, or poor sleep quality; and anxiety and other mood disorders. There is no evidence that pain in the calves, nausea, or vomiting are symptoms of fibromyalgia

The nurse is counseling an adult client with fibromyalgia. What are some elements of counseling that can help this client develop effective coping skills? SATA A) Ask the client about the specific stressors in the client's life and how the client handles them. B) Inform the client about what to do as the disease worsens C) Ask the client about sources of support that the client may be able to rely on D) Advise the client that a dimension of self-efficacy is independently developing a response to the problems of fibromyalgia. E) Suggest to the client that some symptoms may be psychosomatic

A, C Rationale: It helps to identify stressors that make pain and fatigue worse, and then develop strategies to avoid those stressors or to minimize symptoms when those stressors occur. Fibromyalgia is not a progressive disease. Getting appropriate help is important in managing fibromyalgia. Clients should be encouraged to see a fibromyalgia specialist, and self-efficacy means engaging in health-promoting behavior to influence the course of the disease, not developing a treatment plan alone. It is important to validate the client's perceptions.

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? SATA A) Reducing pain B) Improving verbal communication C) Improving physical function D) Increasing restorative sleep E) Ensuring an effective breathing pattern

A, C, D 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 is prescribed a serotinin-norepinephrine reuptake inhibitor. Which side effect of the medication should the nurse include when teaching the client about this medication? SATA A) Dry mouth B) Diarrhea C) Increased sleepiness D) Nausea E) Dizziness

A, D, E Dry mouth Nausea Dizziness Rationale:

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) "Keep your weight down, exercise and get frequent checkups." C) "Take a daily vitamin capsule." D) "Start taking ginkgo biloba."

B) "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 suspected of having fibromyalgia asks why diagnostic tests are being ordered. Which response should the nurse make to this client? A) "Fibromyalgia can be diagnosed with blood and hormone testing. 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) "All clients with this diagnosis have these tests."

B) "The healthcare provider is trying to rule out other causes of your symptoms." Rationale:

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) "Exercise is important: No pain, no gain." B) "You may see a short-term increase in pain and fatigue; these should decrease over time." C) "You are right to quit; exercise should not make your pain and fatigue worse." D) "I exercise three times a week; it makes me feel so much better."

B) "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

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) Daily meditation and guided imagery B) A program of regular, mild to moderate exercises C) Referral to physical therapy for an assistive device D) NSAIDs taken on a regular schedule

B) A program of regular, mild to moderate exercises 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.

A client with fibromyalgia asks which type of exercise would be most effective. Which response should the nurse make to this client? A) Gym-based program B) Aquatic therapy C) Stretching exercises D) Isometric strength training

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.

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) Muscular dystrophy B) Chronic fatigue syndrome C) Osteoarthritis D) Sjogren syndrome

B) 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

A client with fibromyalgia asks why a selective serotonin and noripinephrine re-uptake inhibitor is prescibed for the health problem. Which should the nurse explain as the rationale for this medication? A) Decrease joint pain and swelling B) Increase levels of dopamine and serotonin C) Reduce neuropathic pain D) Relax the client and promote sleep

B) 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 is caring for a client who has recently been diagnosed with fibromyalgia. The client has complained of pain, fatigue, and sleep disruptions. Which medication should the nurse anticipate will most likely be prescribed as part of the client's treatment plan? A) Duloxetine B) Milnacipran C) Pregabalin D) Acetaminophen

B) Milnacipran Milnacipran is a clinical pharmacologic therapy for pain, fatigue, and sleep disruptions for fibromyalgia. Duloxetine and pregabalin are not prescribed for fatigue, and acetaminophen can be used for pain but will not assist with the sleep disturbances.

The mother of three teenagers is diagnosed with fibromyalgia and asks the nurse how to keep up with all the children's activities. Which suggestion by the nurse is the most appropriate? A) Attempt to attend all the functions of the children B) Negotiate with the children to alternate attendance of their functions C) Avoid attending any after school functions for the children D) Ask the children to limit their activities

B) Negotiate with the children to alternate attendance of their functions. Rationale: Because it is too difficult to attend all of the children's functions, the nurse suggests alternating attendance of the children's functions. In this manner, the client feels that she is partially meeting the needs of each child. Not attending any functions will only add to the client's stress and may worsen symptoms. It is not reasonable for a client with fibromyalgia to try to run the home and attend all of the functions of each child. The children should not have to limit their activities because of the client's illness.

Which statement best exemplifies the etiology of fibromyalgia? A) Stress and poor sleep hygiene are the main precipitating factors for fibromyalgia B) No exact cause is known, but some clients with fibromyalgia may have precipitating factors C) The primary cause for fibromyalgia in nearly all clients who have it is infection D) Precipitating factors for fibromyalgia are primarily physiological

B) No exact cause is known, but some clients with fibromyalgia may have precipitating factors. Rationale: The exact cause of fibromyalgia is unknown; over 70% of clients with fibromyalgia have no precipitating factor for the disease. Infections, physical trauma, psychosocial stressors, vaccinations, and chemical substances all might be causative factors for fibromyalgia in some patients.

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? SATA A) Often described as superficial or dry B) Is not the result of inflammation or damage C) Occurs mainly in fingers and toes D) Increased response to painful stimuli E) Sensitivity to stimuli that are not normally painful

B, 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.

The son of a client with fibromyalgia asks the nurse if he will also experience the health problem. Which responses by the nurse are appropriate for this situation? SATA A) If your diet is high in fatty foods, you have a greater chance of developing fibromyalgia B) Having a family member with fibromyalgia increases the risk for developing it C) If you exercise often enough you'll be fine D) Only people aged 20-50 develop fibromyalgia. E) Fibromyalgia is more prominent in women

B, E Rationale: There are many theories about the causes and risk factors about fibromyalgia. It is generally conceded that it is more of a problem for women aged 20—50 than for men. Having a family member with the disease also increases the risk for development. The disease has not been linked to lack of exercise. Diets have been suggested as possible treatment but are not thought to cause the disease.

During a home visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this client? A) "Maybe you should get a new mattress or pillow." B) "You are fatigued because you stay up too late." C) "Your fatigue is most likely the result of sleep disturbances, particularly insomnia." D) "Have you been worried about anything in particular lately?"

C) "Your fatigue is most likely the result of sleep disturbances." Rationale: Fatigue in fibromyalgia is most likely caused by sleep disturbances such as​ insomnia, poor quality of​ sleep, early morning​ awakening, or non-restorative sleep. It is not caused by​ worry, staying up too​ late, or an old mattress or pillow.

During a home visit, the family of a client with fibromyalgia asks the nurse what they can do to help the client with painful episodes. What should the nurse suggest to the client and family? A) Protect the client from injury B) Plan a family reunion or vacation C) Divide household chores among each member of the family D) Keep the client in bed

C) Divide household chores among each member of the family Rationale: Although the causes and treatments are not all known, there is general agreement that reducing stress may help lessen the effects of fibromyalgia. The nurse could help the family by suggesting ways to decrease stress on the client by having the family pitch in on responsibilities. A family reunion or vacation might cause more stress to the client, who would more than likely be planning and packing for such an event. Keeping the client in bed would not be therapeutic. There is no reason to believe that this client is at higher risk for injury than another member of the family.

A man brings his wife to the clinic and states, "I want you to fix my wife and tell her that there is nothing wrong with her." The client has symptoms of pain, sleep disorders, and stiffness. Which would be most appropriate for the nurse to include in a plan of care for this family? A) Medications used to treat fibromyalgia B) An exercise program to increase energy C) Information and literature on fibromyalgia D) Suggested dietary changes to help with the pain

C) Information and literature on fibromyalgia Rationale: Accepting a disease like fibromyalgia may be difficult due to the vagueness of the disease. Information and written literature may help the family understand that the disease is real. The physician orders medication and diets. There is no proof that exercise, or lack thereof, causes fibromyalgia.

A 15-year-old female client diagnosed with juvenile primary fibromyalgia syndrome asks the nurse whether the fibromyalgia can be cured so that she won't have to deal with it as an adult. Which of the following is the best response the nurse could make to this question? A) The fibromyalgia likely can be cured with proper sleep hygiene, exercise, and pharmacologic management B) Fibromyalgia can be difficult to treat effectively, but the symptoms are unlikely to persist into adulthood C) It is likely that the fibromyalgia will persist into adulthood, and there is no cure, but the symptoms can be treated and the condition in not life-threatening D) The client will suffer from persistent fibromyalgia for the remainder of her life unless a cure can be found.

C) It is likely that the fibromyalgia will persist into adulthood and there is no cure, but the symptoms can be treated and the condition is not life-threatening. Rationale: More than 80% of children who have JPFS will have fibromyalgia that persists into adulthood. It is not certain that this client's fibromyalgia will persist into adulthood, but it is likely. There is no cure for fibromyalgia, but it can be treated symptomatically and it is not progressive or life-threatening.

Fibromyalgia is a disorder that involves which of the following? A) Muscle strength B) Respiratory control C) Heat regulation D) Pain processing

D) Pain processing Rationale: Fibromyalgia is a disorder of pain processing, not a disorder of muscle strength, respiratory control, or heat regulation. Pain associated with fibromyalgia results from central amplification of pain signals, including spontaneous nerve activity, enlarged receptive fields, and abnormal levels of neurotransmitters.

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) Pattern of fatigue C) Symptom of severity scale D) Palpation of tenderness points

D) 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.

A client with fibromyalgia is interested in non-pharmacologic therapies to treat the disease. Which therapy should the nurse suggest that the client try? A) Yoga B) Long-distance running C) Herbal therapy D) T'ai Chi

D) 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 identifies the nursing diagnosis of Chronic Pain as being appropriate for a client with fibromyalgia. Which manifestation did the client most likely report that caused the nurse to select this diagnosis? A) Pain from eyestrain B) Pain from a severe skin rash C) Acute chest pain D) Tender points in the knees

D) Tender points in the knees Rationale: Clients with fibromyalgia typically complain of multiple tender points generally including the neck, spine, and knees. Acute chest pain, pain from a rash, and muscle strain of the eye are not reported symptoms.

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) Treatment only includes analgesic medications C) Fibromyalgia treatment follows an algorithm used for every client D) The treatment that works for one client may not work for another.

D) 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 the affected joint B) Septicemia with group A streptococcus infection C) Recent injury to joint or bone D) Viral illness

D) 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.