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1. A 45-year-old male patient presents to the FNP with
complaints of chest pain, dyspnea, and palpitations. He has
a history of hypertension, diabetes, and smoking. He is
currently taking metformin, lisinopril, and aspirin. The
FNP suspects that he may have an acute coronary
syndrome (ACS) and orders an electrocardiogram (ECG)
and cardiac biomarkers. Which of the following ECG
findings is most suggestive of an ACS?
a) ST-segment elevation in two contiguous leads
b) T-wave inversion in leads V1-V4
c) Q waves in leads II, III, and aVF
d) *ST-segment depression and/or T-wave inversion in two
or more leads*
Rationale: ST-segment depression and/or T-wave inversion
in two or more leads is indicative of ischemia, which is a
hallmark of ACS. ST-segment elevation in two contiguous
leads suggests a myocardial infarction (MI), which is a type
of ACS, but not the only one. T-wave inversion in leads
V1-V4 may indicate a right ventricular strain or pulmonary
embolism, which are not related to ACS. Q waves in leads
II, III, and aVF may indicate an old inferior MI, which is
not an acute condition.
2. A 32-year-old female patient visits the FNP for a routine
prenatal check-up at 28 weeks of gestation. She has no
significant medical or obstetric history and her pregnancy
has been uncomplicated so far. She reports feeling well and
has no complaints. The FNP performs a physical
examination and measures her blood pressure, which isÂÂ
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