A nurse is reviewing the laboratory results of a female client who has liver dysfunction a receiving a continuous tube feeding. Which of the findings should the nurse identify as a protein deficiency?

Albumin 3.1 g/dL (3.5 to 5.0 g/dL)

Transferrin 400 mg/dL (250 to 380 mg/dL)

Uric acid 2.3 mg/dL (2.7 to 7.3 mg/dL)

Total iron-binding capacity 488 mcg/dL (250 to 460 mcg/dL)

Answer and Explanation

The Correct Answer is A

A. Albumin 3.1 g/dL (3.5 to 5.0 g/dL)

Albumin is a protein produced by the liver, and its levels are commonly used as an indicator of nutritional status, particularly protein status. In clients with liver dysfunction and receiving continuous tube feeding, a low albumin level indicates protein deficiency. Albumin plays a crucial role in maintaining oncotic pressure in the blood vessels, and decreased levels can lead to fluid shifts and edema, among other complications.

B. Transferrin 400 mg/dL (250 to 380 mg/dL):

Transferrin is a protein involved in iron transport. While high transferrin levels may indicate iron deficiency, they do not directly reflect protein deficiency.

C. Uric acid 2.3 mg/dL (2.7 to 7.3 mg/dL):

Uric acid is a waste product of metabolism. Low uric acid levels are not indicative of protein deficiency; instead, they may be seen in conditions such as liver dysfunction or decreased production of uric acid.

D. Total iron-binding capacity 488 mcg/dL (250 to 460 mcg/dL):

Total iron-binding capacity measures the amount of iron that can be bound by transferrin. Elevated total iron-binding capacity may indicate iron deficiency, but it does not directly reflect protein deficiency.

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Correct Answer is C

Explanation

A. Level of orientation:

The level of orientation refers to the client's cognitive status and ability to understand their surroundings. While important for overall assessment and care planning, it is not typically included in anthropometric assessment, which focuses specifically on physical measurements and characteristics of the body.

B. Respiratory rate:

Respiratory rate is a vital sign that reflects the client's respiratory status and is important for assessing oxygenation and ventilation. However, it is not part of anthropometric assessment, which primarily focuses on physical measurements related to body size, shape, and composition.

C. Weight

Anthropometric assessment involves the measurement of various body dimensions, such as height, weight, and body composition. Weight is a crucial component of anthropometric assessment as it provides information about the client's nutritional status, growth patterns, and overall health. Monitoring changes in weight over time can help identify trends and assess the effectiveness of interventions aimed at improving nutritional status or managing health conditions.

D. Current pain level:

Pain level is important for assessing the client's comfort and managing pain effectively, but it is not included in anthropometric assessment. Anthropometric assessment focuses on objective measurements of body dimensions and characteristics rather than subjective experiences such as pain.

A. Corneas with an opaque appearance B. Pupils that are 8 to 9 mm in diameter C. Eyelashes that curl slightly outward. D. Eyelids that blink involuntarily 30 to 35 times per minute

Correct Answer is C

Explanation

A. Corneas with an opaque appearance:

An opaque appearance of the corneas indicates an abnormal finding and could suggest a pathological condition such as corneal edema, scarring, or infection. The corneas should normally be clear and transparent to allow light to pass through to the retina.

B. Pupils that are 8 to 9 mm in diameter:

Pupils that are 8 to 9 mm in diameter are abnormally large and dilated. Normal pupil size varies between approximately 2 to 4 mm in diameter under normal lighting conditions. An 8 to 9 mm diameter suggests mydriasis, which may be caused by various factors such as medications, neurological conditions, or trauma.

C. Eyelashes that curl slightly outward.

Eyelashes that curl slightly outward are a normal finding and help to protect the eyes by preventing foreign particles from entering. This finding is considered within the range of normal anatomy and physiology of the eye.

D. Eyelids that blink involuntarily 30 to 35 times per minute:

While blinking is a normal physiological response that helps to keep the surface of the eye moist and clear debris, the rate of involuntary blinking typically ranges from 15 to 20 times per minute in adults, not 30 to 35 times per minute. A higher rate of blinking could indicate irritation, dryness, or other ocular discomfort.

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A nurse is reviewing the laboratory results of a female client who has liver dysfunction a receiving a continuous tube feeding. Which of the findings should the nurse identify as a protein deficiency?

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