# A 50-year-old client with fibromyalgia is being started on pregabalin 75 mg PO twice daily. Which assessment finding does the nurse address as most important to monitor and report?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375212&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 50-year-old client with fibromyalgia is being started on pregabalin 75 mg PO twice daily. Which assessment finding does the nurse address as most important to monitor and report?

## Option

1. Mild, transient dizziness and daytime sleepiness during the first week of therapy, a report of occasional dry mouth that resolves with hydration, and a small bruise on the forearm from a minor household accident two days ago.
2. The client mentions feeling slightly "foggy" and less sharp at work, but continues to perform job duties without errors; there is a 1-kg weight loss over the past month, and the client reports an occasional mild headache that responds to acetaminophen.
3. Mild nausea and abdominal bloating that started with pregabalin and persists, occasional loose stools, and a 0.5-kg weight gain over one week, but the client states these symptoms are tolerable and intake is adequate.
4. New peripheral edema with 3 kg weight gain in 2 weeks, blurred vision, increased dizziness or somnolence, mood changes or suicidal thoughts, and any sign of misuse such as running out early or seeking refills repeatedly because pregabalin is Schedule V. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Pregabalin (Lyrica) is a gabapentinoid first-line for fibromyalgia, diabetic neuropathy, postherpetic neuralgia, neuropathic pain associated with spinal cord injury, and as an adjunct for partial-onset seizures. Important nursing assessments and patient teaching: (1) peripheral edema and weight gain — common (sometimes substantial) and may unmask or worsen heart failure; report new lower-extremity edema or sudden weight gain; (2) blurred vision is reported in clinical trials and may resolve or persist; report; (3) CNS — dizziness, somnolence, ataxia, fatigue; older adults at higher fall risk; (4) mood changes and suicidal ideation as a class warning of antiseizure medications; (5) misuse — pregabalin is Schedule V (controlled) because of euphoria potential, especially in patients with substance use disorder history; report early refill requests, dose escalation, lost prescriptions, or concomitant opioid use; (6) renal dose adjustment, gradual taper to discontinue, avoid alcohol and unauthorized CNS depressants; (7) angioedema and serious cutaneous reactions are rare; report facial swelling. Pink urine may be drug-related but is not the priority surveillance, and dry mouth is mild; minor bruise is investigated for fall risk, not Lyrica-specific.

## In-depth explanation

Edema/weight, vision, mood, and misuse signs are the must-monitor cluster for pregabalin. Schedule V status is the most distinct point compared with gabapentin.

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