The nurse is caring for a female patient who reports vomiting blood. The patient's Hgb was 4.2 g/dL (reference range 13.5-18 g/dL), Hct 13.6% (reference range 38-47%), and a WBC of 9,400/mm3 (4500-11,000/mm3). The provider orders 2 units of packed red blood cells (PRBC). The nurse is performing the one-hour assessment during the transfusion of the second unit of PRBCs. The vital signs one hour ago were blood pressure 102/58 mmHg, heart rate 101 bpm, respirations 20, temperature 99.3°F, and pulse oximetry of 95% on room air. Which of the following assessment findings are the most concerning to the nurse?