A nurse is providing care for four patients. Which patient should the nurse evaluate first for cognitive impairment?

Choice A rationale:
It is crucial to prioritize the patient's spouse's emotional needs and preferences during this highly stressful and sensitive situation. Offering the choice to be present during resuscitation demonstrates respect for their autonomy, promotes family- centered care, and facilitates coping mechanisms.
Key considerations supporting this approach:
Respect for Autonomy:
Patients and their loved ones have the right to make informed decisions about their care, including being present during resuscitation efforts.
Respecting this right fosters trust, empowers the spouse, and aligns with ethical principles of patient autonomy. Family-Centered Care:
Family-centered care recognizes the importance of family members in the patient's care and decision-making.
Inviting the spouse to be present demonstrates a commitment to including them in the care process and supporting their emotional needs.
Facilitating Coping Mechanisms:
Witnessing resuscitation efforts can be distressing, but it can also provide closure, acceptance, and the opportunity to say goodbye.
Some individuals find comfort in being present and actively involved, even in difficult circumstances. The nurse can provide emotional support and guidance throughout the process.
Potential Benefits of Presence:
Studies have shown that family presence during resuscitation can have positive outcomes, such as decreased anxiety and post- traumatic stress disorder (PTSD) symptoms in family members.
It may also contribute to greater satisfaction with care and a sense of peace for those who choose to be present.
Rationales for other choices:
Choice B: Requesting that the spouse sit in the waiting room may isolate them and increase their anxiety. It deprives them of the opportunity to be involved in decision-making and potentially delays their grieving process.
Choice C: While the hospital's crisis team can provide valuable support, immediate referral may not align with the spouse's immediate needs or preferences. It's essential to first assess their emotional state and offer the choice of being present.
Choice D: Suggesting prayer may be appropriate for some individuals, but it should not be the first or only option presented. It's important to respect the spouse's spiritual beliefs and offer a range of support options.

Choice A rationale:
Explaining legal requirements to inform sex partners at this initial stage is not the most appropriate or supportive intervention.
The client is in a state of emotional distress and may not be receptive to information about legal obligations. It's crucial to first address the client's emotional needs and provide support before discussing legal matters.
Prematurely focusing on legalities could further overwhelm the client and potentially hinder the development of a trusting relationship with the nurse.
Choice C rationale:
Offering to inform the family for the client, while well-intentioned, may not respect the client's autonomy and right to privacy. The decision to disclose HIV status to family members is a personal one that should be made by the client, not the nurse.
It's important to empower the client to make their own choices about disclosure and provide support throughout the process.
Choice D rationale:
Determining if a clergy member would help could be a valuable resource for some clients, but it should not be the first or only intervention.
It's essential to first assess the client's individual needs and preferences regarding spiritual support.
Not all clients may find comfort in religious or spiritual guidance, and some may prefer to seek support from other sources.
Choice B rationale:
Assessing the client for support systems is the most appropriate initial intervention because it focuses on the client's immediate needs for emotional support and connection.
By identifying existing support systems (such as family, friends, or community organizations), the nurse can help the client access resources that can provide comfort, understanding, and assistance in coping with the diagnosis.
This approach recognizes the client's emotional state and prioritizes their psychosocial well-being, which is essential in the initial stages of coping with an HIV diagnosis.