A nurse is caring for a female client who had a stroke. Which of the following findings should indicate to the nurse that the client has an increased risk of developing skin breakdown?

Skin integrity depends on adequate nutrition, circulation, mobility, and tissue oxygenation. Clients who have had a stroke are already at increased risk for skin breakdown due to immobility, decreased sensation, and reduced ability to reposition independently. Laboratory values can help identify additional risk factors, especially those related to poor nutritional status and delayed wound healing. Low serum albumin is a significant indicator of impaired protein stores and increased susceptibility to pressure injuries. A. 25-Hydroxyvitamin D level of 92 ng/mL is slightly above the reference range but is not a major indicator of skin breakdown risk. Vitamin D is more closely associated with bone health, calcium regulation, and immune support rather than direct pressure injury risk. It does not specifically predict impaired skin integrity in this scenario. B. Albumin 3.1 g/dL is below the normal range and indicates poor nutritional status and decreased protein reserves. Protein is essential for maintaining tissue integrity, collagen synthesis, and wound healing. Low albumin is strongly associated with increased risk of pressure ulcers and delayed healing, especially in immobile clients such as those recovering from stroke. C. WBC 12,000/mm³ indicates mild leukocytosis, which may suggest infection or inflammation. While infection can affect healing, an elevated WBC count alone is not the primary predictor of skin breakdown risk. Nutritional deficits such as low albumin are more directly linked to pressure injury development. D. Hemoglobin 18 g/dL is elevated above the normal range and may suggest dehydration or other hematologic conditions. Low hemoglobin would be more concerning for impaired oxygen delivery and delayed healing. An elevated hemoglobin level does not directly indicate increased risk of skin breakdown in this context.