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

Rationale: A. Pruritus is a common symptom of CKD due to the buildup of uremic toxins and calcium-phosphate crystals under the skin. While uncomfortable, it is not immediately life-threatening and does not require urgent assessment. B. Hypertension is common in CKD as a result of fluid retention and activation of the renin-angiotensin system. Although this blood pressure needs monitoring and management, it is not an emergency requiring first assessment. C. These are uremic manifestations due to the accumulation of ammonia and toxins in the body. They indicate progression of CKD but are not urgent or immediately life-threatening findings. D. Kussmaul respirations are deep, rapid breathing that occur as a compensatory mechanism for metabolic acidosis, a serious and potentially life-threatening complication of CKD. This client should be assessed first to evaluate acid-base balance, respiratory effort, and potential need for urgent intervention such as dialysis or bicarbonate therapy.