A nurse is reviewing the medical record of a client who is taking clozapine. Which of the following findings should the nurse report to the provider immediately?

Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. It carries a black box warning for agranulocytosis, a severe reduction in granulocytes that predisposes patients to fatal sepsis. Monitoring the absolute neutrophil count and leukocyte levels is a mandatory safety requirement for this therapy. Rationale: A. A BMI of 28 indicates that the client is overweight, which is a common metabolic side effect of clozapine therapy. While weight gain should be managed through diet and lifestyle interventions, it does not represent an acute, life-threatening emergency. The nurse should document this finding but prioritize more urgent hematological complications during the assessment. B. A fasting blood glucose of 180 mg/dL indicates hyperglycemia, reflecting the metabolic dysregulation often induced by second-generation antipsychotics. Clozapine can cause insulin resistance and new-onset diabetes mellitus. While this requires medical management and potential pharmacotherapy, it is not as immediately life-threatening as the risk of profound immunosuppression and systemic infection. C. An LDL level of 220 mg/dL signifies hyperlipidemia, which increases the long-term risk of cardiovascular disease in patients taking clozapine. Dyslipidemia is a recognized adverse effect of the medication's impact on metabolic pathways. Although this value requires follow-up and statin therapy, it does not necessitate immediate notification compared to an urgent hematological crisis. D. A WBC count of 2,500/mm3 is a critical finding indicating severe leukopenia and a high risk for agranulocytosis. This condition compromises the immune system, making the client highly vulnerable to life-threatening infections. The nurse must report this to the provider immediately, withhold the medication, and initiate protective isolation protocols to prevent the development of sepsis.