# A hospitalized client develops profuse watery diarrhea after broad-spectrum antibiotics, and stool testing confirms Clostridioides difficile infection. Which nursing actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=370012&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A hospitalized client develops profuse watery diarrhea after broad-spectrum antibiotics, and stool testing confirms Clostridioides difficile infection. Which nursing actions are appropriate? Select all that apply.

1

Give loperamide before consulting the treatment team so bowel motility slows while C. difficile-directed treatment is being arranged

2

Continue Contact Precautions for at least 48 hours after diarrhea resolves, or longer according to facility policy

3

Wear gown and gloves and remove them safely; use soap and water after likely spore contact or during an outbreak, per facility policy

4

Use alcohol-based hand rub after removing visibly contaminated gloves because it reliably destroys C. difficile spores on the hands

5

Clean the room and shared equipment with a standard quaternary ammonium product that has no approved sporicidal claim

6

Use a single-patient room with a dedicated toilet when available and dedicate equipment such as the blood pressure cuff and stethoscope

## Explanation

Confirmed C. difficile infection requires Contact Precautions, preferably in a single-patient room with a dedicated toilet and equipment (Choice 6). CDC recommends continuing precautions for at least 48 hours after diarrhea resolves and allows longer duration according to local policy (Choice 2). Gown and glove technique is essential. When hands are visibly soiled, spore contact is likely, or an outbreak policy applies, wash with soap and water after glove removal; alcohol-based hand rub remains preferred in most other clinical situations and should not be removed from access (Choice 3). Alcohol does not reliably inactivate spores and is not the sole method for visibly contaminated hands (Choice 4). Use an EPA-registered product with a C. difficile sporicidal claim rather than a nonsporicidal routine cleaner (Choice 5). Antimotility medication is not started independently before assessment and effective infection treatment because ileus or severe colitis may be present (Choice 1).

## In-depth explanation

Clinical Judgment
C. difficile spreads by spores that resist alcohol and most routine cleaners. The clinical signal to escalate is soap-and-water hand washing + bleach surface cleaning + contact precautions — the standard hand-hygiene rules do not apply.

Memory Tip
CDI = SOAP for spores: Soap + water (no alcohol) · Own equipment dedicated · Avoid antimotility drugs · Private room with contact precautions.

KR vs US
Korean wards rely heavily on alcohol-based sanitizer at the bedside. NCLEX-RN expects the nurse to switch to soap and running water the moment a client has suspected or confirmed C. difficile, and to maintain precautions for 48 hours after diarrhea resolves.

## Clinical scenario

Clinical Practice Guide
CDC, SHEA, and IDSA C. difficile guidelines establish: contact precautions until 48 hours after diarrhea resolves, soap-and-water hand hygiene during care, sodium hypochlorite environmental cleaning, and oral vancomycin or fidaxomicin as first-line treatment. Antibiotic stewardship is the upstream prevention.

Caution
NCLEX traps: alcohol-based hand sanitizer for CDI, antimotility drugs to slow diarrhea, and ending precautions when the client feels better. Remember: spores survive alcohol and standard cleaners — use bleach and soap.

## Key concepts

- **C. difficile Spores** — Dormant, environmentally resistant forms of Clostridioides difficile that survive on surfaces for months and resist alcohol-based hand sanitizers, quaternary ammonium cleaners, and routine disinfectants. Killed by sodium hypochlorite (bleach), high-temperature laundering, and EPA-registered sporicidal products. NCLEX exam tip: spore-forming organisms always change the hand-hygiene rule to soap and water and the cleaning agent to bleach.
- **Contact Precautions** — Tier 2 transmission-based precautions used for organisms spread by direct contact with the client or contaminated environment. Components: private room (or cohort), gown and gloves on entry, dedicated equipment, and disposal of PPE before exit. Used for C. difficile, MRSA, VRE, RSV, scabies. NCLEX exam tip: contact precautions for C. difficile continue at least 48 hours after diarrhea has resolved.
- **Antimotility Agent Contraindication** — Drugs such as loperamide and diphenoxylate-atropine are contraindicated in suspected or confirmed C. difficile infection because slowing intestinal motility traps toxin in the colon, raising the risk of toxic megacolon, bowel perforation, and sepsis. NCLEX exam tip: an option that suggests an antimotility agent for infectious diarrhea is almost always wrong.

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