A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? Select all that apply.

Choice A rationale Bradypnea is not a typical finding in end stage renal disease. In fact, patients with end stage renal disease often experience metabolic acidosis due to the kidneys' inability to excrete hydrogen ions. To compensate for this acidic state, the respiratory system often increases the rate and depth of breathing, a process known as Kussmaul respirations, to blow off carbon dioxide. Therefore, tachypnea is more common than bradypnea in patients suffering from advanced chronic kidney failure. Choice B rationale Hypertension, rather than hypotension, is a hallmark finding in end stage renal disease. The kidneys play a vital role in regulating blood pressure through fluid volume control and the renin angiotensin aldosterone system. In renal failure, fluid retention and increased renin production lead to persistent elevations in blood pressure. Hypotension is generally only seen in these patients during or immediately after dialysis treatments if excessive fluid is removed too rapidly from the vascular space. Choice C rationale Pruritus, or intense itching, is a very common and distressing symptom of end stage renal disease. It is often caused by the accumulation of uremic toxins in the blood that the failing kidneys can no longer filter out. Additionally, imbalances in calcium and phosphate levels can lead to the deposition of phosphate crystals in the skin, further irritating nerve endings. This condition is sometimes referred to as uremic pruritus and often requires specialized dermatological and systemic management. Choice D rationale While severe uremia can cause neurological changes like confusion or encephalopathy, slurred speech is not a specific or expected finding directly linked to end stage renal disease. Neurological symptoms in renal failure usually manifest as a decreased level of consciousness, tremors, or seizures rather than isolated speech deficits. If slurred speech occurs, the nurse must assess for other potential causes such as a stroke, medication toxicity, or severe electrolyte imbalances like hyponatremia which affects brain function. Choice E rationale Bone pain is a frequent finding in end stage renal disease due to a condition known as renal osteodystrophy. The failing kidneys cannot activate vitamin D, which is essential for calcium absorption, and they fail to excrete phosphorus. High phosphorus levels lead to low calcium levels, which triggers the parathyroid glands to release hormone that pulls calcium from the bones. This process weakens the skeletal structure, leading to significant bone pain, increased fracture risk, and various skeletal deformities.