3.D Fibromyalgia

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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.


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