module 3 comfort fibromyalgia and sleep disorder
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 Rationale: Depression is often a comorbidity with fibromyalgia that requires treatment. Peptic ulcer disease, cardiovascular disease, and lupus are not.
The nurse is monitoring a client who has been using NSAIDs for treatment of chronic back pain for several months. The nurse should instruct the client to take the medicine with food and a full glass of water to address which common side effect? A. Gastric distress B. Pruritus C. Constipation D. Sedation
A Rationale: Gastric distress is a common side effect of NSAIDS. It can be potentially prevented by taking the medication with food and a full glass of water. Pruritus, sedation, and constipation are all side effects of opioids.
The nurse assesses a client for manifestations associated with a sleep-rest disorder. Which should the nurse include when completing the psychosocial assessment? A. Life stressors B. Reflexes C. Muscle tone D. Appearance
A Rationale: Life stressors are included as part of the psychosocial assessment for sleep-rest disorders. Reflexes, muscle tone, and appearance are components of a physical assessment.
The client asks the nurse about biofield therapies to help with chronic pain. Which information should the nurse include about the use of biofield therapies? (Select all that apply.) A. They balance the energy fields in the body that are disrupted by physiologic imbalances. B. This complementary alternative therapy has no side effects or interaction with other treatments. C. Evidence supports the use of these therapies to help people deal with painful experiences. D. Biofield therapies have been around for quite a long time, but they really have no value other than people thinking that they work. E. There is a large repository of evidence that indicates the clinical efficacy of biofield therapy in effectively reducing pain.
A B C Rationale: Evidence supports the use of these therapies to help people deal with painful experiences; they have no side effects, nor do they interact with other treatments; and they balance the energy fields in the body that are disrupted by physiologic imbalances. However, evidence does not yet support clinical efficacy.The statement that they really have no value is a subjective opinion and should not be included in the information provided to the client.
A nurse is caring for a client who is hospitalized because of a fractured femur. The client tells the nurse that it is difficult to get any sleep while in the hospital. What action should the nurse take to minimize environmental stimuli in the hospital environment? (Select all that apply.) A. Keeping the client's door closed B. Minimizing noise from staff interactions C. Adjusting window coverings to block outside lights during the day and night D. Performing only essential activities in the client's room during sleeping hours E. Placing the client in a single-bed room when possible
A B D E Rationale: To reduce environmental stimuli in the hospital environment, the nurse should do all the stated actions, except adjust window coverings to block outside lights during the day and night. The window coverings should be adjusted only at night; during the day, the window coverings should be left open to let in natural light.
Which statement regarding comfort is true? (Select all that apply.) A. It is subjective. B. It can be assessed by vital signs. C. It varies from one individual to another. D. It can be associated with sleep and rest. E. It is objective
A C D
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. Increased response to painful stimuli B. Often described as superficial or achy C. Is not the result of inflammation or damage D. Sensitivity to stimuli that are not normally painful E. Occurs mainly in fingers and toes
A C D 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 nurse teaches the parent of an adolescent client about sleep-rest disorders during puberty. Which risk factor should the nurse emphasize in this teaching? A. Decreased lung capacity B. Delayed melatonin release C. Gastroesophageal reflux disease D. Increased urinary frequency
B Rationale: During adolescence, puberty may cause changes in the body's internal clock, leading to delayed nightly release of melatonin. As a result, delayed sleep phase syndrome may occur. Increased urinary frequency, preexisting gastroesophageal reflux disease, and decreased lung capacity are risk factors associated with the development of sleep-rest disorders during pregnancy.
The parents report that their 6-year-old child is sleepy during the day and wakes up frequently throughout the night. Which question should the nurse ask the parents? A. "Does your child complain of headaches in the morning?" B. "Does your child sleepwalk?" C. "Does your child snore?" D. "Does your child lose control of muscle tone when awake?"
B Rationale: Sleep disturbances in children can be manifested in many ways, including nocturesis, bruxism, and sleepwalking. School-age children are more likely to have sleepwalking and sleep terrors, which can cause anxiety for the parents. The questions, "Does your child snore?" and "Does your child complain of headaches in the morning?" are questions associated with sleep apnea disorders. Loss of muscle control when awake is cataplexy and is associated with narcolepsy.
A client returns to the clinic for follow-up care for fatigue related to sleep apnea obstruction. Which information indicates to the nurse that the plan of care has been successful? A. The spouse reports an absence of snoring. B. The client reports sleeping 7 hours a night. C. The spouse reports a decrease in apneic episodes. D. The client reports a decrease in naps during the day.
B Rationale: Sleeping 7 hours a night indicates the plan of care is working. The recommended hours per night of sleep for an adult is 7 to 8 hours. The client should avoid napping during the day. Naps may be an indicator the interventions did not work and they may interfere with the client's ability to sleep at night. The client's spouse may report a decrease in snoring, not necessarily an absence of snoring. The client's spouse should report no apneic episodes if the plan of care is working.
The nurse is providing education about ongoing care for a client with fibromyalgia. Which information should the nurse include? (Select all that apply.) A. The use of cold therapy B. Information on gymnasium memberships C. Strategies for stress reduction D. Follow-up care E. Use of prescription medications
B 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 client does not want to develop obstructive sleep apnea like an older parent. Which should the nurse recommend to help the client prevent this health problem? A. Routine use of modafinil B. Smoking cessation C. Weight reduction D. Continuous positive airway pressure (CPAP)
C Rationale: Weight reduction is recommended for the client at risk for obstructive sleep apnea.
A client having difficulty sleeping asks if there is an herbal supplement that can help. How should the nurse respond to this client? A. "Melatonin is a very useful sleep aid." B. "Chloral hydrate is an excellent choice to utilize as a sleep aid." C. "Chamomile tea is very soothing and may help you sleep." D. "Valerian root can be taken daily and you should start sleeping better within a few days."
C Rationale: Chamomile tea has a soothing effect that may induce sleep and decrease restlessness, although this effect has not been proven in clinical studies. It is safe for both adults and children except individuals who are allergic to ragweed or daisies. Melatonin is a sleep hormone produced by the pineal gland. Synthetic melatonin may be helpful in regulating sleep patterns. Chloral hydrate is an anxiolytic drug used short-term for insomnia. Valerian root is useful as an herbal sleep aid but must be taken for 2 to 3 weeks before it is effective.
The nurse reviews the medication prescription for a client with restless leg disorder. Which category of medication should the nurse expect to be prescribed for this client? A. Benzodiazepines B. Anticonvulsant agents C. Anxiolytics D. Anti-Parkinson agents
D Rationale: Anxiolytics, benzodiazepines, and anticonvulsant agents are sometimes prescribed for treatment of sleep-rest disorders. Anti-Parkinson agents may be prescribed for clients who experience restless leg disorder.
A client is prescribed a CPAP machine to treat obstructive sleep apnea. Which teaching will the nurse include as a first step to help the client adjust to wearing the mask? A. Wear the mask without air pressure when asleep. B. Wear the mask with air pressure when asleep. C. Wear the mask without the air pressure when awake. D. Wear the mask with the air pressure on when awake.
C Rationale: It is important for the client to get used to wearing the CPAP mask. For the first step in getting used to wearing the mask, the nurse will instruct the client to wear the mask without the air pressure when awake. The second step is to instruct the client to wear the mask with the air pressure on when awake. The third step is to instruct the client to wear the mask with air pressure on when asleep.
A client is transferred from the critical care area to a general medical unit. What action should the nurse take first to help promote sleep? A. Encourage the client to take naps when able, to decrease the impact of the sleep disturbance. B. Contact the healthcare provider to obtain an order for a hypnotic/sedative. C. Ask the family to decrease the number of visits since the client has improved and needs to rest. D. Assess the client's individual circadian rhythm.
D Rationale: It would be important at this point to assess the client's circadian rhythm to schedule routine activities, medications, and so on around the client's normal sleep patterns. It would not necessarily be appropriate at this point to obtain an order for a hypnotic/sedative or to ask the family to decrease the amount of time spent visiting. Naps should be avoided, not encouraged, because they can also disrupt sleep patterns.
While completing an assessment after administration of morphine for acute pain, the nurse notes that the client's respiratory rate is 10 and that the client is very lethargic. Which should the nurse do first in response to these assessment findings? A. Continue to monitor for any further decrease in respirations or change in level of consciousness. B. Immediately obtain a complete set of vital signs to establish a baseline. C. Contact the healthcare provider immediately to advise of client changes. D. Administer naloxone as prescribed in incremental doses until symptoms of overdose are resolved.
D Rationale: Morphine can cause respiratory depression. If this occurs, naloxone should be immediately administered as prescribed in incremental doses until the overdose is resolved. A baseline set of vital signs should be obtained as soon as possible but vital signs are not the first priority. Once naloxone is begun, the healthcare provider should be contacted. The nurse would not just continue to monitor for further changes as this could result in death.
A client with fibromyalgia is interested in nonpharmacologic therapies to treat the disease. Which therapy should the nurse suggest that the client try? A. Yoga B. Herbal therapy C. Long-distance running D. T'ai chi
D 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 reviews the problem list for a client with a sleep-rest disorder. Which problem should the nurse identify as the priority for this client? A. Stress overload B. Insomnia C. Ineffective coping D. Fatigue
Rationale: Insomnia is a priority for the nurse to address for the client with a sleep-rest disorder. Insomnia can be severe enough to affect the client's cognitive ability to function and place the client at increased risk for injury. When the insomnia is addressed, the fatigue may lessen and the client may be more receptive to addressing the stress overload the individual may be experiencing and learning new coping skills for stress
The nurse is teaching a group of staff members about parasomnias. Which example should the nurse use when explaining this disorder? (Select all that apply.) A. Sleep talking B. Night terrors C. Narcolepsy D. Enuresis E. Bruxism
Rationale: Parasomnias include bruxism (grinding teeth), sleep talking, night terrors, and enuresis (bed wetting). Narcolepsy is a form of hypersomnia.
A client is experiencing symptoms of obstructive sleep apnea. Which treatment should the nurse anticipate being used for this client's health problem? A. Continuous positive airway pressure (CPAP) B. Adhesive nasal strips C. Bright light therapy D. Cognitive-behavioral therapy (CBT)
A Rationale: Continuous positive airway pressure (CPAP) is most often used in the treatment of clients who experience obstructive sleep apnea
During an assessment a client explains that discomfort only occurs when using a rowing machine at a local fitness facility. Under which area of the comfort assessment should the nurse document this finding? A. Lifestyle B. Observation C. Current problem D. Client history
A Rationale: During a comfort assessment questions are used to determine lifestyle behaviors that may be related to the discomfort, such as discomfort that occurs during exercise. Thus, this information would best fit within the lifestyle assessment area, not observation, client history, or current problem.
During a home visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this client? A. "Your fatigue is most likely the result of sleep disturbances, particularly insomnia." B. "Maybe you should get a new mattress or pillow." C. "You are fatigued because you stay up too late at night." D. "Have you been worried about anything in particular lately?"
A 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.
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. "My bedroom is restful and free of irritations." C. "I make sure to go to bed and wake up at the same time each day." D. "I listen to music or read before I go to bed."
A 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.
During a home visit, the family caregiver asks what can be done to help the older client get a good night's sleep. Which should the nurse suggest? A. Use flannel sheets to maintain warmth. B. Withhold fluids in the evening to decrease the need to void. C. Wear light-weight clothing. D. Play relaxing music at bedtime.
A Rationale: Interventions to promote warmth and sleep for older adults include the use of flannel sheets to maintain warmth. Physiological changes that may contribute to sleep disorders in older adults are changes in circulation, metabolism, and body tissue density. These changes limit the older adult's ability to generate heat and maintain a comfortable body temperature. For this reason, the nurse would also suggest that the older adult client wear warmer clothing for sleep. Withholding fluids in the evening to decrease the need for the older adult to void may result in dehydration and hypotension. The physiological changes in the older adult result in nocturia.
Which area should the nurse include when conducting the focused physical examination portion of the nursing assessment for a client with fibromyalgia? A. Palpation of tenderness points B. Duration of pain C. Pattern of fatigue D. Symptom severity scale
A 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. The treatment that works for one client may not work for another. B. Treatment only includes analgesic medications. C. Fibromyalgia treatment follows an algorithm that is used for every client. D. Fibromyalgia treatment can be provided only in a hospital or outpatient setting.
A 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.
The nurse is caring for a 5-year-old client experiencing difficulty with sleeping. Which should the nurse discuss with the parents before creating a plan of care for this client? A. Principles of good sleep hygiene B. A plan to implement stimulus therapy C. The child's physiological delay in melatonin release D. The plan to initiate cognitive-behavioral therapy
A Rationale: The nurse should review sleep hygiene with the parents. Sleep hygiene is a critical component for developing healthy sleep habits. Stimulus therapy is used for adults and involves using the bed only for sleep and sex, and not for other activities such as watching TV, reading, or working. Cognitive-behavioral therapy is used for chronic insomnia. A delay in melatonin release that delays sleep is applicable for adolescent children.
Which diagnostic test should the nurse review to determine if a client's discomfort is caused by an infection? A. White blood cell count B. Urine analysis C. Liver function studies D. Hematocrit and hemoglobin
A Rationale: The white blood cell count would be the best study to use to determine if the cause of pain may be due to infection. A urine analysis, liver function studies, and hematocrit and hemoglobin can provide information about other potential issues, but are not the best to determine infection.
A client is scheduled for a polysomnography (PSG) test. Which data should the nurse expect to be collected during this test? (Select all that apply.) A. Eye movements B. Leg movements C. Oxygen saturation D. Heart rate E. Urinary output
A B C D Rationale: Polysomnography (PSG), or a sleep study, is the primary diagnostic test for sleep disorders. Client data collected during a PSG includes oxygen saturation, heart rate, respirations, eye movements, leg movements, and electroencephalogram (EEG) monitoring. Urinary output is not monitored during a PSG
A nurse is caring for a client with a sleep disorder. Which question should the nurse ask about the current problem? (Select all that apply.) A. "Which activities make the discomfort better or worse?" B. "How would you describe your discomfort?" C. "How long have you had this discomfort?" D. "Have you had past experiences that affect the way you view this discomfort?" E. "When did your discomfort start?"
A B C E Rationale: Asking the client about past experiences related to how the client views the current problem would be a question the nurse would ask about health history, not the current problem. All other statements are correct.
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 somatic peripheral nervous system B. The autonomic nervous system C. The cardiac system D. The endocrine system E. The renal system
A B D 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 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. Nonpharmacologic methods of pain relief C. The importance of adhering to an around-the-clock schedule of narcotic analgesics D. Examples of mild to moderate exercise E. Strategies for improving quality of sleep
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.
A client reports pain as being an 8 on a scale from 1 to 10. Which finding should the nurse expect when assessing this client? (Select all that apply.) A. Posturing B. Abnormal gait C. Fever D. Guarding E. Facial grimaces F. Verbal complaints
A B D E F Rationale: Observations associated with discomfort include guarding, posturing, abnormal gait, facial grimaces, and verbal complaints. Fever is not usually associated with discomfort (although it could be a source of discomfort).
The nurse is caring for a client who is in pain because of a back spasm. Which independent nursing intervention should the nurse use for this client? (Select all that apply.) A. Providing distractions B. Positioning the client to promote comfort C. Administering analgesics as ordered D. Ordering physical therapy for the client E. Applying heat or cold as appropriate
A B E Rationale:Independent nursing interventions for a client in discomfort include applying heat or cold as appropriate, providing distractions, and positioning the client to promote comfort. Administering analgesics and ordering physical therapy are collaborative interventions.
A client with fibromyalgia is prescribed a serotonin-norepinephrine reuptake inhibitor. Which side effect of the medication should the nurse include when teaching the client about this medication? (Select all that apply.) A. Dry mouth B. Diarrhea C. Dizziness D. Nausea E. Increased sleepiness
A C D 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.
The nurse reviews concepts that are related to comfort with a group of nursing assistants. Which statement should the nurse include in teaching? (Select all that apply.) A. "Mobility is related to comfort in that decreased mobility is often caused by pain, injury, or disease." B. "Grief and loss is related to comfort in that loss or expected loss of a loved one creates physical discomfort." C. "Tissue integrity is related to comfort in that decreased tissue integrity increases the risk for pain." D. "Inflammation is related to comfort in that inflammation causes pain." E. "Ethics is related to comfort in that healthcare providers may be reluctant to prescribe opioids based on race."
A C D E Rationale: Inflammation is related to comfort in that inflammation causes pain. Mobility is related to comfort in that decreased mobility is often caused by pain, injury, or disease. Tissue integrity is related to comfort in that decreased tissue integrity increases the risk for pain. Ethics is related to comfort in that healthcare providers may be reluctant to prescribe opioids based on race. Grief and loss is related to comfort; however, the loss or expected loss of a loved one creates emotional, not physical, discomfort.
The nurse is caring for a client who is experiencing discomfort from the nasogastric tube that is necessary for gastric suctioning. What relaxation technique should the nurse teach the client to aid in client comfort? (Select all that apply.) A. Breathing exercises B. Laughter C. Guided imagery D. Movement techniques E. Muscle relaxation
A C D E Rationale: Relaxation techniques used to aid in client comfort include movement techniques, breathing exercises, muscle relaxation, and guided imagery. Laughter is beneficial; however, it promotes psychosocial well-being, not relaxation.
Which factor increases an individual's risk for experiencing obstructive sleep apnea? (Select all that apply.) A. Obesity B. Female gender C. Large neck circumference D. Narrow airway E. Smoking
A C D E Rationale: Risk factors associated with the development of obstructive sleep apnea include male gender, large neck circumference, obesity, smoking, and a narrow airway.
The nurse is providing care for a child who is experiencing discomfort due to intermittent urinary catheterizations. Which should the nurse encourage the family to do during the procedure to most appropriately enhance comfort for the child? A. Offer the child a treat such as a sticker or a small toy after the procedure. B. Offer a distraction during the procedure. C. Explain the procedure each time before it is performed to ensure understanding. D. Hold the child while the procedure is being performed.
B Rationale: For the child experiencing discomfort during a procedure such as this, it would be most appropriate to encourage the parents to distract the child. Holding the child would likely complicate completion of the procedure and would not be the best option. While offering the child a treat or small toy after the procedure may help encourage them to cooperate with the procedure, it would not be the most appropriate option to enhance comfort. Explaining procedures can help to decrease anxiety, but doing so each time may not necessarily enhance comfort.
Which sleep-rest disorder should the nurse identify as being the most common? A. Hypersomnia B. Insomnia C. Parasomnia D. Dyssomnia
B Rationale: Insomnia is the most common sleep-rest disorder. Insomnia is the inability to fall or stay asleep. Hypersomnia is extreme daytime drowsiness despite getting sufficient sleep. Parasomnias are abnormal actions during sleep. Dyssomnia is also known as restless leg syndrome.
When reviewing the client's current list of medications, the nurse notes the client is taking modafinil. Which question about the medication should the nurse ask? A. "Are you being treated for muscle weakness associated with narcolepsy?" B. "Are you currently being treated for narcolepsy?" C. "Are you currently being treated for restless leg syndrome?" D. "Are you being treated for insomnia?"
B Rationale: Modafinil is a CNS stimulant prescribed for the client experiencing narcolepsy. Insomnia is treated with different classifications of medications that are based on the type of insomnia the client is experiencing. Restless leg syndrome is treated with different classifications of medications. Muscle weakness associated with narcolepsy is treated with a CNS depressant.
The nurse reviews the universal aspects of comfort with a group of staff members. Which statement should the nurse include? (Select all that apply.) A. Emotional needs are higher priority than are physiological needs. B. Physiological needs include oxygen, shelter, food, water, and sleep. C. Giving and receiving respect are aspects of self-esteem needs. D. Emotional needs include love and belonging from family and friends. E. When physiological needs are met, other needs can be achieved.
B C D E Rationale: Physiological needs include oxygen, shelter, food, water, and sleep. When physiological needs are met, other needs can be achieved. Emotional needs include love and belonging from family and friends. Giving and receiving respect are aspects of self-esteem needs.
The nurse is caring for a pregnant client who appears to be experiencing discomfort related to the pregnancy. What content should the nurse include in the teaching plan to enhance comfort for this client? (Select all that apply.) A. Taking over-the-counter pain medication B. Eating a balanced diet C. Drinking enough water D. Refraining from daily exercise E. Getting enough rest
B C E Rationale: The pregnant client who is experiencing discomfort related to pregnancy should be taught the importance of adequate nutrition, hydration, and sleep and rest. The pregnant client should not be encouraged to take over-the-counter pain medication unless directed by the healthcare provider. The nurse would provide tips on daily activity, but the pregnant client would not need to refrain from daily exercise.
Which factor influences the expression of pain regardless of culture, and is important for the nurse to consider for all clients? (Select all that apply.) A. Underlying health of the client B. Client's skills at reporting pain and discomfort C. Cues from client's family or significant others D. Client's ability to cope with pain E. Client's level of trust in the healthcare provider
B D E Rationale: The client's ability to cope with pain, skills at reporting pain and discomfort, and level of trust in the healthcare provider are important factors to consider for all clients, regardless of culture. Underlying health issues and cues from significant others are not vital to understanding how clients express pain.
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. Isometric strength training C. Aquatic therapy D. Stretching exercises
C 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.
The nurse is completing an assessment on a client experiencing lower back pain for several weeks. Which question should the nurse ask to obtain more information about the client history? A. "Do you think that your occupation may be contributing to the back pain?" B. "Do you believe it may be related to another disease or condition?" C. "How often does the lower back pain occur?" D. "How does the lower back pain affect your daily activities?"
C Rationale: Asking how often the lower back pain occurs would provide more information for the client history. Asking if it affects daily activities or if they think it is related to another disease or condition would answer questions related to the current problem. Asking if they think their occupation may be contributing to it would support lifestyle.
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. "I exercise three times a week; it makes me feel so much better." B. "You are right to quit; exercise should not make your pain and fatigue worse." C. "You may see a short-term increase in pain and fatigue; these should decrease over time." D. "Exercise is important: No pain, no gain."
C 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.
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. "Fibromyalgia can be diagnosed with blood and hormone testing." C. "The healthcare provider is trying to rule out other causes of your symptoms." D. "The healthcare provider is just trying to determine your general state of health."
C 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.
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. Sjögren syndrome C. Chronic fatigue syndrome D. Muscular dystrophy
C 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.
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. Referral to physical therapy for an assistive device C. A program of regular, mild to moderate exercise D. Nonsteroidal anti-inflammatory drugs (NSAIDs) taken on a regular schedule
C 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.
The nurse is providing care to a client who is approaching the end of life. Which intervention most directly helps to promote psychosocial comfort? A. Reviewing advance directives to ensure end-of-life care desires B. Providing adequate pain relief with pharmacologic agents C. Offering to arrange a visit from a spiritual leader or loved ones D. Removing all tubes and medical monitoring devices
C Rationale: Offering to arrange a visit by a spiritual leader or loved ones can help to enhance psychosocial comfort. Pain-relief medications can help to enhance physical comfort. Reviewing advance directives can help to ensure that end-of-life decisions are honored. Removing all tubes and medical devices will not necessarily enhance psychosocial comfort.
Which occurrence should the nurse expect to assess as a precipitating factor for the symptoms of fibromyalgia in a client? A. Septicemia with group A streptococcus infection B. Recent injury to joint or bone C. Viral illness. D. Bacterial infection of affected joint
C 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. Next Question
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. Ensuring an effective breathing pattern C. Improving physical function D. Reducing pain E. Increasing restorative sleep
C D 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 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. Decrease joint pain and swelling B. Relax the client and promote sleep C. Reduce neuropathic pain D. Increase levels of dopamine and serotonin
D 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 uses Maslow's hierarchy of needs to help identify a client's care issues. What should the nurse recall as being the highest level of this hierarchy? A. Safety and security B. Self-esteem C. Love and belonging D. Self-actualization
D Rationale: According to Maslow's hierarchy of needs, the highest level of basic human need is self-actualization. The other answer choices are levels of the hierarchy; however, they are incorrect choices.
A client recovering from a tonsillectomy to treat sleep apnea is being discharged. Which should the nurse identify as the major concern for this client? A. The client is unable to utilize a CPAP machine. B. The treatment may be ineffective. C. The client may need further surgery if apnea continues. D. The client is at increased risk for adverse events.
D Rationale: After a tonsillectomy, snoring will not occur as an indication of apneic periods. The tonsillectomy may be ineffective and further treatment may be required. The client may use a CPAP machine when fully recovered from surgery.
The nurse plans care for a client with a sleep disturbance. Which should the nurse identify as an appropriate goal for this client? A. The client will wake no more than once during the night. B. The client will initiate an earlier bedtime. C. The client will implement relaxing music to induce sleep. D. The client will initiate relaxation techniques 45 minutes prior to bedtime.
D Rationale: An appropriate goal for the nurse to include in the plan of care for the client with a sleep disturbance is the client initiating relaxation techniques 45 minutes prior to bedtime. This promotes relaxation prior to attempting to sleep. It is not necessary to initiate an earlier bedtime; changing a routine may result in worsening the issues associated with the sleep disturbance. The client should be instructed to reduce or remove environmental distractions from the bedroom. The goal for the plan of care is to have the client sleep through the night. Waking in the night may result in inadequate sleep.
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. "Take a daily vitamin capsule." B. "Start taking ginkgo biloba." C. "Follow a vegetarian diet." D. "Keep your weight down, exercise, and get frequent checkups."
D 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 reports sudden muscle and leg weakness and excessive fatigue despite sleeping 7 hours a night. Which sleep disorder should the nurse suspect this client is experiencing? A. Sleep loss B. Restless leg syndrome C. Insomnia D. Narcolepsy
D Rationale: The client sleeping 7 hours a night, experiencing sudden muscle weakness is describing symptoms of narcolepsy. Narcolepsy is a condition where the client experiences excessive daytime sleepiness even with adequate nighttime sleep, resulting in sleep attacks and cataplexy. Insomnia is characterized by difficulty falling asleep or maintaining sleep or by a short sleep duration even with adequate time spent attempting to fall asleep. Sleep loss refers to a duration of sleep shorter than the recommended 7 to 8 hours per night for adults. Restless leg syndrome (RLS) is a neurologic disorder that results in an irresistible urge to move the legs or other body parts, often resulting in impaired sleep habits.
