During assessment of the patient diagnosed with fibromyalgia, what would the nurse expect the patient to report in addition to widespread pain?

Nonrestorative sleep with resulting fatigue.

Widespread musculoskeletal pain that is accompanied by inflammation and fever.

Generalized muscle twitching and spasms.

Profound and progressive muscle weakness that limits ADLs.

Answer and Explanation

The Correct Answer is A

Choice A reason: Nonrestorative sleep with fatigue is a core fibromyalgia symptom, alongside widespread pain. Disrupted sleep architecture, including reduced deep sleep, exacerbates pain sensitivity and fatigue, driven by central nervous system dysregulation. Recognizing this guides management with sleep hygiene, medications like amitriptyline, and exercise to improve sleep quality and reduce fatigue.

Choice B reason: Fibromyalgia does not involve inflammation or fever, unlike rheumatoid arthritis. It’s a noninflammatory pain syndrome with central sensitization. Expecting inflammation or fever misdiagnoses fibromyalgia, potentially leading to inappropriate treatments like corticosteroids, which are ineffective, delaying proper care with antidepressants or physical therapy for pain and fatigue.

Choice C reason: Generalized muscle twitching and spasms are not typical fibromyalgia symptoms. These suggest neurological conditions like myoclonus or electrolyte imbalances. Fibromyalgia involves diffuse pain and tenderness, not spasms. Assuming twitching misguides assessment, risking incorrect interventions and overlooking fibromyalgia’s core symptoms like sleep disturbance and fatigue.

Choice D reason: Profound muscle weakness limiting ADLs is characteristic of neuromuscular diseases like myasthenia gravis, not fibromyalgia. Fibromyalgia causes pain and fatigue, not progressive weakness. Expecting weakness misdirects diagnosis, potentially leading to unnecessary neurological testing, delaying fibromyalgia management with exercise, cognitive therapy, and medications to address pain and fatigue.

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Correct Answer is B

Explanation

Choice A reason: Tennis involves high-impact movements, twisting, and sudden directional changes, which stress the lumbar spine and exacerbate low back pain. These actions increase pressure on intervertebral discs and strain paraspinal muscles, risking further injury. For clients with back pain, low-impact exercises are preferred to avoid aggravating the condition.

Choice B reason: Swimming is a low-impact aerobic exercise that strengthens core and back muscles without stressing the spine. Buoyancy in water reduces gravitational load on vertebrae, minimizing disc compression. Freestyle or backstroke promotes spinal alignment and flexibility, making it an ideal recommendation for managing low back pain safely and effectively.

Choice C reason: Rowing involves repetitive forward flexion and rotation, which can strain lumbar muscles and compress spinal discs, worsening low back pain. The seated position and pulling motion increase intradiscal pressure, risking injury. This high-intensity activity is not suitable for clients seeking back pain relief through exercise.

Choice D reason: Canoeing requires prolonged sitting and repetitive twisting, which stress the lower back. The forward paddling motion increases lumbar flexion, straining muscles and discs. This activity is not recommended, as it can exacerbate pain and lacks the supportive, low-impact qualities needed for safe back pain management.

A. Pitting edema of the hands and fingers. B. A dry, red rash across the bridge of the nose and on the cheeks. C. A grey colored, non-purpuric papular rash. D. Subcutaneous nodules on the ulnar side of the arm.

Correct Answer is B

Explanation

Choice A reason: Pitting edema of the hands and fingers is not a typical SLE finding. It may occur in conditions like heart failure or nephrotic syndrome, but SLE more commonly causes joint swelling or effusions due to synovitis. Expecting edema misdirects assessment, potentially overlooking SLE’s hallmark cutaneous and musculoskeletal symptoms critical for diagnosis.

Choice B reason: A dry, red rash across the nose and cheeks, known as a malar or butterfly rash, is a hallmark of SLE, present in 30-60% of patients. This photosensitive rash results from autoimmune-mediated cutaneous inflammation, aiding diagnosis. Its distinct pattern distinguishes SLE from other dermatologic conditions, guiding targeted treatment.

Choice C reason: A grey, non-purpuric papular rash is not characteristic of SLE. SLE rashes are typically erythematous and photosensitive, like the malar rash, or discoid with scaling. A grey papular rash suggests conditions like lichen planus, not SLE, and including it risks misdiagnosis, delaying appropriate immunosuppressive therapy.

Choice D reason: Subcutaneous nodules on the ulnar arm are more typical of rheumatoid arthritis, not SLE. SLE may cause cutaneous lupus lesions, but nodules are rare. Expecting this finding could lead to confusion with other connective tissue diseases, misguiding assessment and delaying SLE-specific treatments like hydroxychloroquine

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During assessment of the patient diagnosed with fibromyalgia, what would the nurse expect the patient to report in addition to widespread pain?

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