A 47-yeаr-оld Cаucаsian female presents tо the ED with an abrasiоn requiring stitches on her head. The client provides an overview of her health history, including 22 pack-years of cigarette smoking, dyspepsia, chronic pulmonary disease (COPD), cholecystectomy last year, and amputation of the two lateral fingers on her right hand due to an accident approximately 4 years ago. The nurses' initial assessment findings include the following. Which of the following findings require follow-up by the nurse? Select all that apply.