# A nurse is assigning rooms for clients with multidrug-resistant organisms: MRSA wound infection, VRE colonization, and CRE pneumonia. Which actions are appropriate when private rooms are limited? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse is assigning rooms for clients with multidrug-resistant organisms: MRSA wound infection, VRE colonization, and CRE pneumonia. Which actions are appropriate when private rooms are limited? Select all that apply.

1

Place all three clients and their different multidrug-resistant organisms together in one private cohort room because any MDRO precaution is sufficient for the group

2

If private rooms are unavailable, cohort only clients with the same organism and do not mix different MDROs

3

Share a blood pressure cuff, stethoscope, and thermometer among the clients and disinfect them only after the final assessment

4

Use a private room when available, prioritizing CRE and other epidemiologically important organisms based on transmission risk

5

Post precaution signage, place PPE supplies at the entry, and dedicate noncritical equipment to each client or disinfect it between clients

6

Don gown and gloves before entry, remove them before leaving, and perform hand hygiene; use soap and water for C. difficile according to policy

## Explanation

Use a private room for epidemiologically important organisms such as CRE when available (Choice 4). When cohorting is necessary, place together only clients with the same organism, not MRSA, VRE, and CRE together (Choice 2). Post signs and PPE supplies and dedicate equipment or disinfect it between clients (Choice 5). Don gown and gloves before entry, remove them before exit, and perform appropriate hand hygiene (Choice 6). Mixing different MDROs or sharing equipment without disinfection promotes cross-transmission (Choices 1 and 3).

## In-depth explanation

MDRO Isolation Hierarchy
1. Single private room — first choice; prioritize for CRE > VRE > MRSA
2. Cohort same organism — 2 MRSA clients together OK
3. NEVER mix different MDROs in one room — cross-colonization risk
4. Last resort: roommate with low transmission risk (no wounds, no devices, immunocompetent)

Contact Precautions PPE
- Don gown + gloves before entry
- Remove inside room before exit
- C. difficile: soap and water (NOT alcohol-based hand rub)
- Dedicate equipment (BP cuff, stethoscope, thermometer) to each client
- PPE cart + signage outside the room

Pathogen Priority
CRE > VRE > MRSA for private room when limited
(CRE = Carbapenem-Resistant Enterobacterales — high mortality, few antibiotics)

Memory Tip
"Single first; same-only cohort; never mix; soap for spores"

## Clinical scenario

Scenario
Med-surg unit, 3 MDRO clients + limited private rooms: MRSA wound, VRE rectal, CRE pneumonia.

Bed Assignment Priority
1. Private room → CRE (highest transmission/mortality)
2. Next: VRE single or cohort with another VRE
3. MRSA single or cohort with another MRSA
4. NEVER cohort different MDROs together

Care Bundle
- Don gown/gloves before entry, remove inside before exit
- Soap-and-water for C. diff clients
- Dedicate non-critical equipment per client
- PPE cart + signage outside room

Avoid
- Mixing different MDROs
- Sharing BP cuff/stethoscope without disinfection
- Alcohol-based hand rub for C. difficile

## Key concepts

- **Multidrug-Resistant Organisms (MDROs)** — Bacteria resistant to multiple antimicrobial classes. Common examples: MRSA (Methicillin-Resistant Staphylococcus aureus), VRE (Vancomycin-Resistant Enterococcus), CRE (Carbapenem-Resistant Enterobacterales — highest priority due to limited treatments and high mortality), ESBL-producing organisms, MDR-Acinetobacter, MDR-Pseudomonas. Transmission predominantly via contact; require contact precautions and rigorous environmental cleaning.
- **Cohorting Principles for MDROs** — When private rooms are unavailable, clients with the SAME MDRO may share a room (cohorted). Different MDROs must NEVER be mixed because cross-colonization can occur (e.g., a MRSA client could acquire VRE). Priority for the limited private rooms: highest-priority pathogens first (CRE > VRE > MRSA), clients with uncontained drainage or extensive devices, immunocompromised roommates avoided. Hand hygiene, dedicated equipment, and signage are required regardless of room sharing.
- **Contact Precautions and PPE Technique** — Required for MRSA, VRE, CRE, C. difficile, scabies, and others. Don gown and gloves BEFORE entering the room; remove gown and gloves INSIDE the room (in the designated area) before exiting to avoid contaminating the corridor. Hand hygiene immediately after PPE removal. C. difficile: soap and water hand hygiene only — alcohol-based hand rub does NOT kill spores. Dedicate non-critical equipment (BP cuff, stethoscope, thermometer) to each isolated client; if equipment must be shared, disinfect between clients per facility protocol.

## Related questions

- [A nurse is caring for a client newly admitted with suspected methicillin-resistant Staphyl…](https://mymerci.kr/pages/nclex_q.php?qn_id=360517&lang=en)
- [A nurse is about to enter the room of a client with Clostridioides difficile infection dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=361226&lang=en)
- [A 22-year-old female client presents to the emergency department with a 4-week history of …](https://mymerci.kr/pages/nclex_q.php?qn_id=361677&lang=en)
- [A 65-year-old client admitted to the medical ICU with sepsis and acute delirium has just p…](https://mymerci.kr/pages/nclex_q.php?qn_id=361679&lang=en)
- [A new graduate registered nurse (RN) on a medical unit just hung an intravenous antibiotic…](https://mymerci.kr/pages/nclex_q.php?qn_id=361710&lang=en)
- [A nurse is caring for a client newly admitted with active Clostridioides difficile infecti…](https://mymerci.kr/pages/nclex_q.php?qn_id=363996&lang=en)
- [A nurse is caring for an adult client newly admitted with suspected active pulmonary tuber…](https://mymerci.kr/pages/nclex_q.php?qn_id=366306&lang=en)
- [A nurse cares for a client newly admitted with a positive surveillance culture for vancomy…](https://mymerci.kr/pages/nclex_q.php?qn_id=366709&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=368203&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._