Match List I (ECG Leads) with List II (Placement Position):

• List I:
• (A) V1,
• (B) V4,
• (C) V5,
• (D) V6
• List II:
• (I) 5th Intercostal space, mid axillary line,
• (II) 5th Intercostal space, anterior axillary line,
• (III) 5th Intercostal space, mid clavicular line,
• (IV) 4th Intercostal space, Right margin of sternum.

1. A

   (A)–(IV), (B)–(III), (C)–(II), (D)–(I)

2. B

   (A)–(III), (B)–(IV), (C)–(I), (D)–(II)

3. C

   (A)–(II), (B)–(I), (C)–(III), (D)–(IV)

4. D

   (A)–(I), (B)–(II), (C)–(IV), (D)–(III)

Appeared in: BHU NO - 12 April 2024

Explanation

• V1 is placed at the 4th intercostal space at the right margin of the sternum.
• V4 is placed at the 5th intercostal space at the midclavicular line.
• V5 is placed at the 5th intercostal space at the anterior axillary line, horizontally even with V4.
• V6 is placed at the 5th intercostal space at the midaxillary line, horizontally even with V4 and V5.
• Proper anatomical positioning ensures accurate recording of the heart's electrical activity across the horizontal plane.

Why Other Options Were Wrong

• Option B: Incorrectly pairs V1 with the 5th intercostal space midclavicular line (which is V4) and V4 with the 4th intercostal space right sternal margin (which is V1).
• Option C: Incorrectly pairs V1 with the anterior axillary line (which is V5) and V4 with the midaxillary line (which is V6).
• Option D: Incorrectly pairs V1 with the midaxillary line (which is V6) and V4 with the anterior axillary line (which is V5).

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Anatomical placement of precordial (chest) ECG leads as background academic context rather than a clinical decision trigger.
• Accurate placement of chest leads is critical; misplacement by even one intercostal space can alter the ECG morphology, potentially leading to misdiagnosis of conditions like myocardial infarction or bundle branch blocks.
• Nurses must palpate the Angle of Louis to accurately locate the 2nd intercostal space and count down to ensure correct positioning of V1 and V2.
• What if? If a patient has dextrocardia, the nurse must place the precordial leads on the right side of the chest (V1R to V6R) in a mirror image of the standard left-sided placement.

How to Approach the Question

• Identify the question type as a matching recall question focused on anatomical landmarks for ECG leads.
• Start with the most distinct and easily remembered lead: V1 is always located at the 4th intercostal space on the right sternal margin. This matches (A) to (IV).
• Look at the options: only Option 1 pairs (A) with (IV), which immediately identifies the correct answer.
• Verify the remaining matches: V4 is at the midclavicular line (III), V5 is at the anterior axillary line (II), and V6 is at the midaxillary line (I).
• Confirm that all matches align with standard clinical practice before selecting the final answer.

Concept Tested & Keywords

• Concept Tested: Anatomical placement of precordial (chest) ECG leads
• Stem keywords: ECG Leads, Placement Position, V1, V4, V5, V6
• Lead-in keywords: Match
• Clinical cues: Accurate placement of precordial leads is essential for correct interpretation of the electrocardiogram.

Question ID

QA_YGgUQplhebsBHcHIkPF

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 469