# Stage 2 — Analyze cues. Complete each blank to connect appropriate testing, immediate precautions, initial treatment, and follow-up testing for suspected CDI.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372794&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Stage 2 — Analyze cues. Complete each blank to connect appropriate testing, immediate precautions, initial treatment, and follow-up testing for suspected CDI.

In a client with unexplained new diarrhea and no recent laxative use, test an unformed stool when there are ::선택::one or morethree or moreten or more episodes in 24 hours. Contact precautions should begin ::선택::while evaluation is pendingonly after imaging shows colitisafter the treatment course ends. For an initial CDI episode, ::선택::IV vancomycinoral metronidazolefidaxomicin is preferred when available, while oral vancomycin remains acceptable. If symptoms resolve, ::선택::a repeat test of curea hydration reassessmenta medication review should not be performed.

## Explanation

Four evidence-based decisions
Test an unformed stool in a client with three or more new unexplained unformed stools in 24 hours after reviewing laxatives and alternative causes. Begin contact precautions while evaluation is pending. For an initial CDI episode, fidaxomicin is preferred when resources permit and oral vancomycin remains acceptable. When symptoms resolve, do not perform a repeat test of cure.

## In-depth explanation

Step 1 — Test the right client and specimen
New unexplained diarrhea establishes pretest probability. Review laxatives and other causes, then send only unformed stool through the facility's diagnostic-stewardship algorithm.

Step 2 — Isolate before confirmation
CDC recommends isolation and contact precautions for suspected or confirmed CDI so transmission prevention does not wait for the laboratory result.

Step 3 — Apply the treatment hierarchy
IDSA/SHEA conditionally prefers fidaxomicin for an initial episode because of sustained response; a standard oral vancomycin course remains an acceptable alternative when resources or access limit fidaxomicin.

Step 4 — Avoid test-of-cure error
Repeat testing is not recommended after symptoms resolve because a client may remain colonized despite clinical recovery.

NCLEX rule
Link symptoms, specimen quality, immediate isolation, resource-sensitive treatment, and clinical follow-up.

## Clinical scenario

Scenario (Stage 2 — Analyze cues)
The client has six new watery stools without recent laxative use after significant antibiotic exposure.

Clinical judgment target
Distinguish immediate precautions and appropriate testing from premature or unnecessary repeat testing.

## Key concepts

- **Diagnostic stewardship** — Testing only an appropriate symptomatic client with an unformed specimen and interpreting results within the clinical context.
- **Initial CDI therapy** — Fidaxomicin is preferred when available for an initial episode; oral vancomycin remains an acceptable alternative.
- **Test of cure** — Repeat C. difficile testing after symptom resolution, which is not recommended because persistent colonization can produce a positive result.

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