An adult client who has a severe neurocognitive impairment is scheduled for gallbladder surgery. With regard to the informed consent, which should the nurse implement first to facilitate the scheduled surgery?

A mentally impaired client is not competent to sign an informed consent, so the nurse should first verify the identity of the client's legal guardian. This action fulfills part of the nurse's duty in informed consent, helps avoid improperly signed documents, and directs the surgeon to the legal representatives of the client's interests. The client and/or legal guardian is asked about the existence of an advance directive at the time of admission, so this should have already been done, making option 2 incorrect. The surgeon is responsible for obtaining the informed consent, but based on the options provided, option 3 is not the first nursing action. Likewise, option 4 is not the first action; the nurse checks identity of the legal guardian first.