# Stage 6 — Evaluate outcomes. Review the clinical trend and select the best evaluation and discharge infection-control plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372798&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Stage 6 — Evaluate outcomes. Review the clinical trend and select the best evaluation and discharge infection-control plan.

| Time | Data |
| --- | --- |
| Hospital day 4 — suspected CDI | Six watery stools since 0400; T 37.9 C; HR 96; BP 118/72; WBC 14.2; creatinine 1.1 from baseline 1.0; contact precautions initiated |
| Hospital day 4 — confirmed CDI | GDH antigen and toxin EIA positive; no hypotension, ileus, or megacolon; fidaxomicin started; unnecessary non-CDI antibiotics stopped; individualized fluid replacement underway |
| Hospital day 5 | Two unformed stools in 24 hours; T 37.2 C; HR 84; BP 120/74; WBC 12.0; creatinine 1.1; oral intake and urine output improving |
| Hospital day 8 | No unformed stools for 48 hours; most recent stool formed; T 36.8 C; HR 76; BP 122/78; WBC 8.8; creatinine 1.0; tolerating prescribed therapy |

Q1. How is the client responding to treatment?

Clinically improving without evidence of fulminant disease; complete the prescribed course and do not perform a test of cure
Worsening because a negative PCR has not yet documented eradication
Treatment failure requiring immediate surgery despite stable abdominal and hemodynamic findings

Q2. What is the best discharge infection-control plan?

Follow facility duration policy, complete EPA List K terminal cleaning, and teach soap-and-water handwashing, home surface cleaning, and recurrence warning signs
End precautions based on a repeat negative test and use any general disinfectant without checking the label
Stop CDI therapy now because stools formed and omit household prevention teaching
Use alcohol-based hand sanitizer alone after toileting because symptoms have improved

## Explanation

Trend interpretation
Decreasing and then resolved unformed stools, restored hydration and renal function, stable abdominal and hemodynamic findings, normalized WBC, and treatment tolerance support clinical improvement. Complete the prescribed course and do not obtain a test of cure. Maintain contact precautions for at least 48 hours after diarrhea resolves or longer according to facility policy, perform EPA List K terminal cleaning at discharge, and teach home handwashing, environmental cleaning, medication completion, and recurrence warning signs.

## In-depth explanation

Step 1 — Evaluate the whole trajectory
Stool frequency, hydration, urine output, creatinine, WBC, temperature, abdominal findings, and hemodynamics improve together. No fulminant features appear.

Step 2 — Do not invent a laboratory cure endpoint
Clinical recovery is not defined by a negative PCR or a rigid combination of formed stool, afebrile status, and normal WBC. Repeat testing after symptom resolution is not recommended because colonization can persist.

Step 3 — Close the environmental loop
Continue precautions for at least 48 hours after diarrhea resolves or longer per policy and complete terminal cleaning with an EPA List K product used for its labeled contact time.

Step 4 — Prevent recurrence and household spread
Finish therapy, wash hands with soap and water after toileting and before eating, clean the bathroom and high-touch surfaces appropriately, avoid unnecessary antibiotics, and report recurrent or worsening symptoms promptly.

NCLEX rule
Evaluate clinical recovery, remaining transmission risk, and the next prevention plan without ordering a test of cure.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
The client has had no unformed stools for 48 hours and is preparing for discharge while completing CDI therapy.

Clinical judgment target
Recognize improvement, avoid repeat testing, and preserve infection-control and recurrence-prevention measures.

## Key concepts

- **Clinical CDI improvement** — Improving diarrhea, hydration, abdominal findings, renal function, inflammatory markers, hemodynamics, and treatment tolerance rather than a negative test result.
- **Persistent colonization** — Continued detection of C. difficile after symptoms resolve, which is why repeat testing is not used as proof of cure.
- **Terminal cleaning** — Discharge or transfer cleaning with an EPA List K sporicidal product used according to label directions, including required wet-contact time.

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