The oncology nurse reviews the record before the next infusion. Which findings require immediate follow-up? Highlight the findings associated with possible bleomycin pulmonary toxicity.

Nurses' Notes 0810: The client arrives for the fourth cycle of a chemotherapy regimen that includes bleomycin. Previous infusions were completed without an acute hypersensitivity reaction or respiratory complaint. The client reports a dry cough that began five days ago and now wakes the client at night. The client also reports shortness of breath while walking from the parking area to the clinic. Mild nausea occurs on the first day after treatment and improves with the prescribed antiemetic. The nurse notes fine crackles at both posterior lung bases that were not documented at the previous visit. The oral temperature is 37.2 °C, and the client denies fever, chills, or recent sick contacts. The client has stable darkening of the skin over the elbows since the second cycle. Hair thinning is unchanged from the prior assessment and the scalp remains intact. Pulse is 96/min and respirations are 22/min at rest. Room-air oxygen saturation has decreased from a baseline of 98% to 92% today. The client reports a small mouth sore that healed three days ago. Weight is unchanged, and there is no new lower-extremity swelling or calf tenderness. The client says fatigue improves after resting in the afternoon. The nurse delays releasing the infusion and contacts the oncology provider with the respiratory assessment.