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

Rationale: A. Itching (pruritus) in CKD is caused by uremic toxin buildup and high phosphorus levels. While uncomfortable, it is not immediately life-threatening. B. Blood pressure of 158/90 mm Hg indicates hypertension, which is a chronic issue in CKD but does not require immediate intervention compared with acute complications. C. Halitosis and stomatitis are signs of uremia, common in CKD, but they are not acutely dangerous and can be managed after more urgent needs are addressed. D. Kussmaul respirations are deep, labored breathing that occur in response to metabolic acidosis, a serious CKD complication due to the kidneys’ inability to excrete acid. This is a life-threatening condition requiring immediate assessment and intervention.