# Place the following actions in the correct order for a nurse caring for a hospitalized client with new-onset unexplained diarrhea and suspected Clostridioides difficile infection.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568363&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Place the following actions in the correct order for a nurse caring for a hospitalized client with new-onset unexplained diarrhea and suspected Clostridioides difficile infection.

Don gown and gloves, then assess the client for signs of severe disease and confirm the stool is unformed.

Perform hand hygiene with soap and water after removing PPE.

Move the client to a private room and initiate contact precautions.

Notify the receiving department and arrange transport of the specimen.

Collect a fresh unformed stool specimen and label it.

## Explanation

The nurse must first implement transmission-based precautions to protect the roommate and staff, then assess the client's clinical status and verify that testing is appropriate. A fresh unformed stool specimen is collected only after precautions and assessment. Communication and environmental cleaning occur after specimen collection and before leaving the room. Hand hygiene with soap and water is performed after doffing PPE because alcohol-based hand rubs do not kill C. difficile spores.

## In-depth explanation

Quick answer
The correct order is: 1) Move the client to a private room and initiate contact precautions; 2) Don gown and gloves, then assess the client for signs of severe disease and confirm the stool is unformed; 3) Collect a fresh unformed stool specimen and label it; 4) Notify the receiving department and arrange transport of the specimen; 5) Perform hand hygiene with soap and water after removing PPE.

Why this is correct
Isolation and contact precautions are the first priority to prevent transmission of C. difficile spores. Assessment and confirmation of testing appropriateness precede specimen collection to avoid unnecessary testing. Specimen collection follows assessment. Communication and transport of the specimen occur after collection. Hand hygiene with soap and water is performed after doffing PPE to remove spores from hands.

Clinical picture
C. difficile infection is a healthcare-associated infection spread via spores that can survive on surfaces for months. Contact precautions include a private room, gown and gloves for all room entry, and dedicated equipment. Testing should be performed only on unformed stool from symptomatic patients. Hand hygiene with soap and water is preferred over alcohol-based hand rubs because alcohol does not kill spores.

Memory hook
The sequence follows the nursing process: first ensure safety (isolation), then assess, then intervene (collect specimen), then communicate, then perform final hygiene. Remember: isolate before you investigate.

NCLEX decision rule
Follow the CDC 2026 acute-care guidance: isolate symptomatic patients with unexplained diarrhea immediately; do not wait for test results. Use gown and gloves for all contact with the patient or environment. Collect stool specimen only if unformed. Use soap and water for hand hygiene after caring for patients with suspected C. difficile.

Why the alternatives are wrong
If the client were already in a private room with contact precautions in place, the first action would be to don PPE and assess. If the stool were formed, testing would not be indicated and the nurse would reassess for other causes. If the client had severe disease (e.g., hypotension, ileus), the nurse would prioritize hemodynamic support and notify the provider before specimen collection.

Sources
1NCSBN 2026 NCLEX-RN Test Plan
2CDC 2026: Clinical Guidance for C. diff Infection Prevention
3CDC 2026: C. diff Facts for Clinicians

## Clinical scenario

A client on a medical-surgical unit developed four watery stools over the past 6 hours. The client received broad-spectrum antibiotics for pneumonia 5 days ago and has no history of laxative use. The client is in a semi-private room with a roommate. The nurse reviews the facility's infection prevention policy and the 2026 CDC acute-care guidance.

## Key concepts

- **Contact precautions** — A set of practices used to prevent transmission of infectious agents that are spread by direct or indirect contact with the patient or the patient's environment. For C. difficile, this includes a private room, gown and gloves for all room entry, and dedicated equipment.
- **C. difficile spores** — Dormant, highly resistant forms of the bacterium that can survive on surfaces for months and are not killed by alcohol-based hand rubs. Soap and water hand hygiene is required to physically remove spores from hands.
- **Unformed stool** — Stool that takes the shape of the container (e.g., liquid or semi-liquid). Only unformed stool should be tested for C. difficile because formed stool indicates colonization, not active infection.

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