# At 0800, the nurse receives report on 5 clients. The nurse will use the required PPE and perform hand hygiene before and after every client, so the order of care will not change the risk of cross-transmission. Place the clients in the order in which the nurse should see them, based on the urgency of each client's needs.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617263&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

At 0800, the nurse receives report on 5 clients. The nurse will use the required PPE and perform hand hygiene before and after every client, so the order of care will not change the risk of cross-transmission. Place the clients in the order in which the nurse should see them, based on the urgency of each client's needs.

Client with C. difficile on contact precautions, vitals at baseline, oral vancomycin due at 0900

Client with an MRSA wound on contact precautions, pain 7/10, PRN oxycodone due, vitals at baseline

Client with neutropenia (ANC 300/mm3), new temperature of 38.3 C, HR 104/min, BP 112/70 mm Hg

Client 2 days after appendectomy, pain 2/10, vitals at baseline, discharge teaching before 1500

Client with influenza on droplet precautions, SpO2 86% on 2 L/min, RR 32/min, using accessory muscles

## Explanation

Because PPE and hand hygiene are used between every client, urgency alone decides the order. The client with influenza and SpO2 86% with accessory muscle use has a breathing problem and is first; the client with neutropenic fever needs antibiotics within about 1 hour and is second. Uncontrolled pain of 7/10 comes next, then the C. difficile medication due at 0900, and last the stable postoperative client whose teaching can occur any time before 1500.

## In-depth explanation

Quick answer
Influenza with hypoxia, neutropenic fever, MRSA wound with pain 7/10, C. difficile with a 0900 dose, then the postoperative client.

Why this is correct
The stem removes cross-transmission from the decision by stating that PPE and hand hygiene are used between all clients, so the sequence follows urgency. Breathing (SpO2 86%, RR 32, accessory muscles) comes first. Neutropenic fever is a time-critical emergency. Severe pain with a due PRN dose is an active need now; a scheduled medication due in 1 hour is next; teaching with a 1500 deadline is last.

Easy analogy or mental picture
Think of an emergency department triage line: the person struggling to breathe goes first, the one with a time-critical infection next, then the one in pain, then scheduled tasks, then routine teaching.

Memory hook
Airway/breathing > time-critical emergency > active symptom > scheduled task > routine teaching.

NCLEX decision rule
Follow the ordering principle the stem gives; when PPE and hand hygiene are guaranteed, clean-to-dirty sequencing does not override clinical urgency.

Why the other choices are wrong
The classic trap is to see the neutropenic client first to protect the immunocompromised client, but the stem states that PPE and hand hygiene prevent cross-transmission, and the client with SpO2 86% cannot wait. Placing the postoperative client early follows clean-to-dirty habit, yet this client is stable and has until 1500. Leaving the C. difficile client last because of spores ignores that PPE is used for everyone and that the vancomycin dose at 0900 is more time-bound than afternoon teaching; the MRSA client comes before it because pain of 7/10 is an active need now.

References
1NCSBN: NCLEX Test PlansEstablishing priorities and applying transmission-based precautions are tested nursing competencies
2CDC: Guideline for Isolation PrecautionsPPE and hand hygiene between clients prevent cross-transmission regardless of the order of care

## Clinical scenario

Scenario
Five clients with different isolation precautions and different levels of urgency must be sequenced at the start of the shift.

## Key concepts

- **Febrile neutropenia** — Fever in a client with a low neutrophil count, treated as an emergency needing prompt antibiotics.
- **Accessory muscle use** — Use of neck and chest muscles to breathe, a sign of increased work of breathing.
- **Clean-to-dirty sequencing** — Caring for uninfected or protected clients before clients with transmissible organisms; not the deciding rule when urgency differs.

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