A female in her late twenties stumbled into the emergency room, her face flushed and sweaty. Upon initial assessment, the triage nurse observed rapid breathing and mild confusion. The patient reported a persistent headache lasting several days, for which she had been self-medicating with an undetermined amount of Aspirin. Given this clinical picture, the triage nurse suspected possible salicylate toxicity and began a focused assessment. Which of the following manifestations would the triage nurse identify as a classic finding of salicylate toxicity?