A 58-yr-old male patient who is diagnosed with nephrotic syndrome has ascites and 4+ leg edema. Which patient problem is present, based on these findings?

A. Inadequate nutrition: Clients with nephrotic syndrome can experience protein loss in the urine leading to malnutrition, but the presence of ascites and 4+ leg edema directly indicates fluid retention rather than poor nutrition alone. B. Poor perfusion: Poor perfusion is associated with signs such as hypotension, weak pulses, or cool extremities. While edema can impair tissue oxygenation to some extent, the primary problem here is not circulatory perfusion but excessive fluid accumulation. C. Activity intolerance: Activity intolerance may develop secondarily due to discomfort from edema and ascites, but it is not the central issue reflected in the assessment findings. The immediate problem is fluid overload causing the visible physical changes. D. Excess fluid volume: The hallmark signs of nephrotic syndrome include severe edema and ascites caused by low serum albumin and fluid shifting into interstitial spaces. These findings clearly demonstrate fluid retention, making excess fluid volume the primary patient problem.