A client has cloudy urine with a strong odor and complains of urgency. What condition does the nurse suspect?

Rationale:

A. Proteinuria is the hallmark finding in nephrotic syndrome. This condition results from increased permeability of the glomerular basement membrane, allowing large amounts of protein, primarily albumin, to leak into the urine. The loss of protein in urine leads to foamy or frothy urine, which is often one of the first noticeable signs. Proteinuria also contributes to hypoalbuminemia, resulting in decreased plasma oncotic pressure, fluid shifting into interstitial spaces, and subsequent edema, commonly seen in the face, periorbital area, and lower extremities.

B. Nephrotic syndrome typically causes hyperlipidemia, not a decrease. The liver compensates for low plasma oncotic pressure by increasing lipoprotein synthesis, leading to elevated cholesterol and triglyceride levels in the blood.

C. On the contrary, nephrotic syndrome causes hypoalbuminemia due to excessive urinary loss of albumin. Low serum albumin contributes directly to the development of edema.

D. Urine output is often normal or may even be reduced in nephrotic syndrome. The condition is characterized by protein loss, not an increase in volume output. Fluid retention is more common due to hypoalbuminemia and sodium retention.

Rationale:

A. Joint pain is not a symptom of asthma. Asthma is a chronic inflammatory airway disease and does not directly affect joints. Joint pain may indicate other conditions such as arthritis or autoimmune disorders, but it is unrelated to asthma.

B. Chest tightness is a common symptom of asthma. Airway inflammation and bronchoconstriction reduce airflow, leading to a sensation of pressure or tightness in the chest, often accompanied by difficulty breathing. This is particularly noticeable during an asthma exacerbation or after exposure to triggers.

C. Increased appetite is not associated with asthma. Appetite changes are unrelated to the pathophysiology of airway inflammation and bronchospasm.

D. Wheezing is a hallmark sign of asthma. It occurs due to turbulent airflow through narrowed bronchi and bronchioles caused by bronchospasm, mucus accumulation, and airway edema. Wheezing is often expiratory and may be audible without a stethoscope in severe cases.

E. Coughing is another key symptom of asthma. It can be dry or productive and is often worse at night or early morning. Coughing results from airway irritation and inflammation and may be the only presenting symptom in some patients, known as cough-variant asthma.