Progressive Care Nursing Certification (PCCN) Practice Exam

A patient reports sharp, constant chest pain that worsens when lying down. What is the most likely cause of these symptoms?

1. ACS

2. Pericarditis

3. PE

4. AAA

The correct answer is: Pericarditis

The presentation of sharp, constant chest pain that worsens when lying down is highly indicative of pericarditis. This condition involves inflammation of the pericardium, the fibrous sac surrounding the heart. A classic characteristic of pericarditis is that the pain often improves when the patient sits up or leans forward, contrasting with the worsening of pain when lying flat. Sharp pain that is positional points towards a process that is likely related to the heart or the surrounding structures, and pericarditis is known to produce this type of discomfort. Additionally, pericarditis may be accompanied by a pericardial friction rub, which can be heard during auscultation, further supporting the diagnosis. While other conditions like acute coronary syndrome (ACS), pulmonary embolism (PE), and abdominal aortic aneurysm (AAA) can cause chest pain, their pain characteristics and accompanying symptoms differ. For instance, ACS typically presents with pressure-like pain and may not be position-dependent. PE might cause pleuritic pain that worsens with deep breathing, but positional changes do not have the same effect. AAA can present with back pain or a tearing sensation and does not typically correlate with positional changes in pain. Recognizing the unique features