A nurse is caring for a client. The nurse is assessing the client. Select the 4 findings that require immediate follow-up.

A. Sleep pattern: The client has not slept for 2 days, which places them at risk for physical exhaustion, impaired cognition, and potential cardiovascular complications. Acute sleep deprivation in a patient with manic episode requires prompt intervention. B. Hallucinations: The client is reporting auditory hallucinations (listening to unseen others), indicating a possible psychotic component. Hallucinations pose safety risks and require immediate psychiatric assessment and monitoring. C. Heart rate: The client’s heart rate is 120/min, which is above normal limits (tachycardia). Combined with sleep deprivation and poor nutrition, this could lead to cardiovascular compromise and warrants urgent evaluation. D. Hygiene: Poor hygiene reflects functional decline and self-care deficits. While concerning for ongoing care needs, it does not require immediate medical intervention compared with acute physiologic or psychiatric risks. E. Skin turgor: Poor skin turgor indicates dehydration, likely secondary to inadequate oral intake. Dehydration can cause electrolyte imbalances and hemodynamic instability, making it a priority finding for follow-up.