# A nurse is assessing a patient with suspected pleurisy. Which assessment finding is most characteristic of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541317 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a patient with suspected pleurisy. Which assessment finding is most characteristic of this condition? ## 보기 1. Sharp, stabbing chest pain that increases with inspiration **✔ 정답** 2. Dull, aching chest pain that radiates to the left arm 3. Crushing chest pain with associated nausea and diaphoresis 4. Burning chest pain that worsens when lying flat **정답: 1** ## 해설 Sharp, stabbing chest pain that increases with inspiration is the hallmark of pleurisy due to inflamed pleural membranes rubbing during breathing. Other options describe pain patterns typical of myocardial infarction, GERD, or musculoskeletal issues. ## 심화 해설 Understanding Pleurisy: The Hallmark Symptom The correct answer is 1. Sharp, stabbing chest pain that increases with inspiration. This is the pathognomonic feature of pleurisy, also known as pleuritis. To understand why, you must consider the anatomy and pathophysiology of the pleura. The pleura is a two-layered membrane. The visceral pleura covers the lungs, and the parietal pleura lines the inside of the chest wall. Normally, a small amount of fluid between these layers allows them to glide smoothly against each other during breathing. In pleurisy, inflammation of these pleural layers occurs. This causes the normally smooth surfaces to become rough and irritated. When the patient inhales, the lungs expand, forcing the inflamed visceral and parietal pleurae to rub against each other. This friction generates a characteristic sharp, stabbing pain localized over the affected area. The pain is directly linked to the respiratory cycle, worsening with deep breathing, coughing, or sneezing, and it is typically relieved or lessened by holding one's breath or splinting the chest wall. This clinical sign, known as pleuritic chest pain, is the key differentiator from cardiac or gastrointestinal sources of chest pain. The provided case report on primary Sjögren's syndrome (pSS) complicated by pleuritis illustrates this concept in a clinical context. The abstract highlights that a patient's respiratory symptoms can be a manifestation of an underlying inflammatory process like pleuritis, even when other comorbidities like COPD are present [1]. While the report focuses on a rare systemic cause, the fundamental mechanism of the pain remains the same: inflammation of the pleural membranes. The report underscores that recognizing this characteristic pain pattern is crucial for early diagnosis, as it can be easily mistaken for an exacerbation of a pre-existing condition like COPD or an infection [1]. As a nurse, your assessment must pinpoint the quality of the pain and its relationship to the breathing cycle to differentiate pleuritic pain from other types. Why the Other Options Are Incorrect * 2. Dull, aching chest pain that radiates to the left arm: This pain quality and radiation pattern are classic for cardiac ischemia or a myocardial infarction. It is not a feature of pleural inflammation. * 3. Crushing chest pain with associated nausea and diaphoresis: This is another classic presentation of an acute myocardial infarction. The "crushing" quality and accompanying autonomic symptoms (nausea, sweating) are hallmark signs of a cardiac event, not pleurisy. * 4. Burning chest pain that worsens when lying flat: This is highly suggestive of gastroesophageal reflux disease (GERD). The burning quality and positional worsening (lying flat allows gastric acid to reflux more easily into the esophagus) are key indicators of a gastrointestinal etiology.References (research sources) - [1]Primary Sjögren's syndrome complicated by pleuritis and pleural effusion: a case report and review of the literature.Case reportBam N, Pokhrel M, Shrestha B, Dhenga S, Rauniyar S. (2026) · DOI: 10.1097/ms9.0000000000004836 ## 임상 시나리오 Clinical Guide: Assessing Pleuritic Chest Pain When assessing a patient with suspected pleurisy, focus on the hallmark symptom: sharp, stabbing pain that worsens with deep inspiration, coughing, or sneezing. The pain is typically localized and may be relieved by shallow breathing or splinting the affected side. Key Assessment Findings - Pleuritic friction rub: A leathery, grating sound heard on auscultation during inspiration and expiration, indicating inflamed pleural surfaces rubbing together. - Splinting behavior: The patient may lean toward the affected side or hold the chest wall to limit movement and reduce pain. - Dyspnea: Often present due to pain limiting chest expansion. Differential Diagnosis Considerations - Cardiac pain: Typically described as pressure, tightness, or crushing, often radiating to the left arm or jaw, and associated with exertion. - GERD-related pain: Burning sensation that worsens when lying flat or after meals, often relieved by antacids. - Musculoskeletal pain: Reproducible with palpation or movement of the chest wall, not necessarily linked to the respiratory cycle. Nursing Interventions - Administer prescribed analgesics and anti-inflammatory medications to manage pain and underlying inflammation. - Teach the patient to use splinting techniques, such as holding a pillow against the chest when coughing or deep breathing. - Encourage frequent position changes and ambulation as tolerated to prevent complications like atelectasis or pneumonia. - Monitor respiratory status closely, including oxygen saturation, breath sounds, and respiratory rate. ## 핵심 개념 - **Pleurisy** — Inflammation of the pleura, the double-layered membrane surrounding the lungs and lining the chest wall, causing sharp chest pain during breathing. - **Pleuritic Chest Pain** — A sharp, stabbing pain that intensifies with deep inspiration, coughing, or sneezing due to the friction of inflamed pleural surfaces. - **Pleura** — A two-layered serous membrane consisting of the visceral pleura (covering the lungs) and the parietal pleura (lining the chest wall). ## 같은 주제 문제 - [A nurse is assessing a patient with suspected pleurisy. 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