A nurse is planning to teach a group of newly licensed nurses about hypernatremia. Which of the following manifestations should the nurse include in the teaching?

A. Mucous membranes: Although they are noted to be dry, this alone is not an urgent finding. Mild dehydration may be monitored, especially when the client is stable and has IV access established.
B. Integumentary findings: Scratch marks and intense pruritus are consistent with cholestasis from liver dysfunction. This can lead to excoriation, infection, or indicate worsening hepatic failure, especially in the context of jaundice and elevated bilirubin.
C. Emesis: No vomiting or emesis is mentioned anywhere in the case details, making this an irrelevant and unsupported option for follow-up.
D. Behavior: The client is disoriented to time and displaying agitation with inappropriate language. In a client with alcohol use disorder and cirrhosis, this behavior can indicate the onset of hepatic encephalopathy which can rapidly progress and require immediate attention.
E. AST result: The AST level is significantly elevated (208 units/L), but liver enzymes are not immediate threats requiring urgent action. They confirm liver injury but do not direct acute intervention.
F. Vital signs: The client has a significantly elevated blood pressure (188/94 mmHg), tachycardia (120/min), and an increased temperature (38.4°C). These may reflect an acute withdrawal syndrome, sepsis, or intracranial injury—all of which demand urgent follow-up.
G. Movement of hands and fingers: There is no indication of tremors, asterixis, or motor deficits in the notes. Therefore, hand and finger movement does not currently present as a priority concern.

A. Review the facility policy about the use of an interpreter: Reviewing the policy ensures compliance with institutional and legal standards for providing language services, helping the nurse arrange an appropriate and qualified interpreter.
B. Request an interpreter of a different gender from the client: Gender preferences may vary by culture, but requesting a different-gender interpreter without considering the client's preferences may cause discomfort or miscommunication.
C. Direct attention toward the interpreter when speaking to the client: The nurse should maintain eye contact and speak directly to the client to foster trust and communication, rather than addressing the interpreter.
D. Request a family member or friend to interpret information for the client: Using untrained individuals may lead to misinterpretation, violate confidentiality, and is discouraged except in emergencies when no professional is available.