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In situations where a patient's preferences are unclear and there is no family or documentation available to guide decision-making, calling for an ethics consult is the most appropriate first action for a Clinical Nurse Leader (CNL). This is because ethical dilemmas often arise in healthcare settings, especially when critical decisions need to be made regarding a patient’s care without clear guidance from the patient themselves.

An ethics consult brings together a team of experts—often including ethicists, legal advisors, and healthcare professionals—who can analyze the situation thoroughly using established ethical principles. They can help navigate the complexities surrounding patient autonomy, best interests, and potential outcomes, ensuring that the decision made is in the best context for the patient.

Choosing other options, such as voting among staff nurses or relying on a social worker for recommendations, may not address the ethical implications adequately and could lead to conflicts or decisions that lack a solid ethical foundation. Conducting a literature review on the quality of life for elderly patients might provide useful information but is not a practical or timely response in an urgent clinical scenario. Therefore, seeking an ethics consult is the first, most responsible step to ensure the patient's rights and best interests are respected according to ethical standards in healthcare.