A client is placed on fluid restriction because of chronic kidney disease (CKD). Which assessment finding would alert the nurse to a fluid volume excess?

Choice A reason: The absence of adventitious sounds in the lungs is a normal and desirable finding. It indicates that the client does not currently have pulmonary edema or fluid accumulation in the alveolar spaces. This would suggest that the fluid restriction is effective rather than alerting the nurse to a volume excess. Choice B reason: Decreased calcium levels (hypocalcemia) are common in chronic kidney disease due to the kidneys' inability to activate Vitamin D and the reciprocal relationship with phosphorus. While it is a significant finding in CKD, it is an electrolyte imbalance rather than a direct clinical indicator of fluid volume overload or excess. Choice C reason: Increased edema in the legs, especially peripheral pitting edema, is a classic clinical sign of fluid volume excess. In CKD, the kidneys fail to excrete sufficient sodium and water, leading to increased hydrostatic pressure in the venous system, which forces fluid into the interstitial spaces of the lower extremities. Choice D reason: Increased phosphorus levels (hyperphosphatemia) occur in CKD because the failing kidneys cannot adequately filter and excrete phosphate. Similar to calcium, this is a metabolic and electrolyte complication of the disease process itself and does not serve as a primary clinical marker for the state of fluid volume.