The client also has the nursing diagnosis Decreased Cardiac Output related to decreased plasma volume. Which assessment finding supports this nursing diagnosis?

• A. Flattened neck veins when the client is in the supine position
• B. Full and bounding pedal and post-tibial pulses
• C. Pitting edema located in the feet, ankles, and calves
• D. Shallow respirations with crackles on auscultation

Answer: (A)

When plasma volume is reduced, venous return to the heart decreases, which lowers preload and thereby reduces cardiac output. The best assessment that reflects this is flat neck veins when the client is supine, because low filling of the central venous system results in minimal visible jugular venous distention. In hypovolemia, the body’s compensatory mechanisms may increase heart rate, but the neck veins remain flattened due to reduced volume.

The other findings point to different situations: full and bounding pulses suggest adequate or excess volume rather than deficit; pitting edema indicates fluid overload or increased hydrostatic pressure rather than lacking volume; shallow respirations with crackles imply pulmonary fluid overload or edema, not low circulating volume.