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 is