While working in the Kathmandu valley, I stayed in a mostly Newar neighborhood. There they spoke mostly Newari, Nepali and English, since the majority of the neighborhood was middle- to upper-class. I also visited a Buddhist guru, or teacher, who spoke Mandarin and Tibetan with his family, because his wife is Tibetan. Up in the mountains, many people speak Nepali and Sherpa, but also speak English well so they can work in the big tourism business.
People typically only exchange Nepali rupees, or rupiyãs, but foreigners typically have to buy airplane tickets in U.S. dollars because foreigners and Nepalis pay different amounts for their flights. In the mountains, though, people have to carry a lot of Nepali cash on hand because they can only find ATMs in big cities.
A liter bottle of mineral water costs 100 N.R.S. in my hotel in Namche Bazaar, which is about the same as in Lukla. These prices stay a bit higher than the valley prices, which may be 10 to 30 N.R.S. cheaper because everything here has to be flown in or carried up the mountain.