A nurse is caring for a client who has fluid volume excess (FVE) due to heart failure (HF). Which of the following manifestations should the nurse associate with FVE? (Select all that apply.)

Rationale: A. Weight gain is correct because rapid or unexplained weight gain is a hallmark sign of fluid volume excess. In heart failure, the heart’s impaired pumping ability leads to fluid retention, which accumulates in the interstitial and intravascular spaces. Nurses often monitor daily weights to detect small changes (usually 2–3 pounds in 24 hours or 5 pounds in a week) that may indicate worsening fluid overload. Weight gain in this context is a reliable, objective measure of FVE. B. Dizziness is incorrect. Dizziness is more commonly associated with fluid volume deficit (FVD), hypotension, or reduced cerebral perfusion. In FVE, blood pressure is often normal or elevated due to increased intravascular volume, so dizziness is not a typical finding. C. Pedal edema is correct. Excess fluid in FVE collects in dependent areas, such as the feet, ankles, and lower legs, due to gravity. This peripheral edema is often bilateral in heart failure. The severity can be graded (1+ to 4+) based on depth and persistence of pitting. Edema occurs because increased venous pressure and fluid retention overwhelm the body’s ability to return fluid to circulation. D. Flat neck veins is incorrect. In FVE, jugular venous distention (JVD) is a classic finding caused by increased central venous pressure. Flat neck veins indicate low central venous pressure, as seen in hypovolemia or fluid volume deficit, which is opposite of what occurs in FVE. E. Thready pulse is incorrect. A thready, weak pulse is more commonly associated with FVD, reflecting reduced intravascular volume. In contrast, FVE typically presents with a bounding or full pulse due to increased circulatory volume and stroke volume.