The nurse is caring for four clients with chronic kidney disease (CKD). Which client would the nurse assess first upon initial rounding?

A. Client with pruritus: Pruritus is a common symptom in CKD due to uremic toxin accumulation and dry skin. While uncomfortable and important to address, it is not immediately life-threatening and does not indicate acute deterioration of kidney or cardiovascular function. B. Client with a blood pressure of 158/90 mm Hg: Elevated blood pressure is common in CKD due to fluid retention and RAAS activation. Although it requires monitoring and possible intervention, this level is not immediately critical unless accompanied by symptoms of hypertensive emergency. C. Client with muffled heart sounds: Muffled heart sounds in a CKD patient may indicate pericardial effusion or uremic pericarditis, which can rapidly progress to cardiac tamponade, a life-threatening emergency. Immediate assessment and intervention are needed to prevent hemodynamic compromise. D. Client with oliguria: Oliguria indicates reduced urine output and worsening kidney function, but it is typically a gradual change in CKD and not immediately life-threatening unless accompanied by electrolyte imbalances or signs of fluid overload.