A nurse is receiving bedside shift report on four assigned patients. Using clinical judgment and priority-setting principles, which patient requires the nurse to assess first?

A 55-year-old patient with an acute kidney injury (AKI) whose morning potassium level is 5.1 (normal 3.5-5.0) and who is waiting for the stat dose of sodium polystyrene sulfonate (Kayexalate) to be delivered from the pharmacy.

A 72-year-old patient 4 hours post-percutaneous coronary intervention (PCI) with a non-bleeding groin puncture site and a reported dull, constant backache rated 4/10.

A 45-year-old patient with a history of seizures who missed the 0600 dose of phenytoin (Dilantin) because it was held for a critically low albumin level.

A 60-year-old patient with chronic obstructive pulmonary disease (COPD) and a tracheostomy whose heart rate is 105/min (baseline 88/min) and whose family member reports a sudden increase in noisy respirations.