A nurse is preparing to administer clindamycin 300 mg by intermittent IV bolus over 30 min to a client who has a staphylococcal infection.
Available is clindamycin 900 mg in 50 mL. How many mL/hr should the nurse set the IV pump to? (Round to the nearest whole number, use a leading zero if it applies, do not use a trailing zero)

Choice A is incorrect: Caffeine can worsen sleep disturbances, a common symptom of fibromyalgia.
Choice B is incorrect: While duloxetine is a medication used to manage fibromyalgia symptoms, taking it at a specific time for increased energy is not directly related to understanding the disease itself.
Choice C is incorrect: Fibromyalgia is a chronic condition with no cure. Chemotherapy is not indicated for its treatment.

Choice D is correct: Low-impact aerobics like walking, swimming, or yoga are recommended non-pharmacological interventions for fibromyalgia. They can improve cardiovascular health, flexibility, and pain management.
Additional notes:
Other non-pharmacological management strategies for fibromyalgia include stress management techniques, cognitive behavioral therapy, and adequate sleep hygiene.
Early and comprehensive management of fibromyalgia can significantly improve quality of life.

Choice A rationale:
History of rheumatologic conditions: Research has demonstrated a link between fibromyalgia and other rheumatologic conditions, such as rheumatoid arthritis, lupus, and osteoarthritis. Individuals with these conditions may have a predisposition to developing fibromyalgia due to shared genetic factors, immune system dysregulation, and chronic inflammation.
Choice B rationale:
Nutritional deficiency: While nutritional deficiencies, particularly in vitamin D, magnesium, and iron, have been associated with fibromyalgia symptoms, there's not enough evidence to establish them as direct risk factors for its development.
Nutritional deficiencies can worsen pain and fatigue, but they aren't considered primary causes of fibromyalgia.
Choice C rationale:

Previous injury to the bone: Past bone injuries typically aren't considered a risk factor for fibromyalgia. Fibromyalgia is a chronic pain syndrome that affects muscles and soft tissues, not bones themselves. While pain from an injury might trigger fibromyalgia symptoms, it's not a direct cause.
Choice D rationale:
Deep sleep deprivation: Sleep disturbances, especially disruptions in deep sleep (also known as slow-wave sleep), are strongly linked to fibromyalgia. Deep sleep is crucial for restorative processes in the body, including pain regulation. Insufficient deep sleep can lead to heightened pain sensitivity and contribute to the development of fibromyalgia.
Choice E rationale:
Physical and emotional trauma: Physical and emotional trauma, such as experiencing accidents, abuse, or significant psychological stress, can significantly increase the risk of developing fibromyalgia. Trauma can trigger changes in the brain's pain processing pathways and stress hormone regulation, contributing to chronic pain and other fibromyalgia symptoms.