RN Nursing · Systemic Lupus Erythematosus · Practice question
A patient with lupus reports sharp chest pain worsened by inspiration and lying flat. Knowing the effect of the disorder, what do you think is likely the cause?
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Myocardial infarction
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✓
Pleuritis
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Pulmonary embolism
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GERD
Answer & explanation
Correct: Pleuritis
Systemic lupus erythematosus (SLE) is an autoimmune disease that causes inflammation of serosal surfaces throughout the body, including the pleura surrounding the lungs. Pleuritis, or inflammation of the pleural lining, classically presents with sharp, stabbing chest pain that worsens with inspiration (pleuritic chest pain) and with lying flat, both of which increase pleural tension and stretch the inflamed tissue. This presentation is highly characteristic and well-recognized in SLE patients. Myocardial infarction typically presents with crushing, pressure-like chest pain that radiates to the arm or jaw and is not characteristically worsened by inspiration or lying flat; SLE can cause pericarditis or atherosclerosis, but the described symptom pattern points away from MI. Pulmonary embolism can cause pleuritic chest pain but is distinguished by additional features such as dyspnea, tachycardia, and risk factors like immobility; while possible, the clinical context of SLE makes pleuritis the more likely answer. GERD causes burning epigastric or retrosternal discomfort that may worsen when lying flat but is not typically sharp or worsened by breathing. Given the known pathophysiology of SLE and the classic symptom description, pleuritis is the most likely cause.
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