# On a long-term care unit, three residents on one hallway developed vomiting and watery diarrhea within 24 hours, and norovirus is suspected. A 78-year-old resident last vomited at 0600 today; it is now 1400, and the resident asks to eat lunch in the dining room. The resident's roommate has no symptoms. A nursing assistant on the unit reports having had diarrhea overnight. Which actions should the nurse take? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=en > language: en > subject: Standard/Transmission-Based Precautions/Surgical Asepsis > category: SIPC ## Question On a long-term care unit, three residents on one hallway developed vomiting and watery diarrhea within 24 hours, and norovirus is suspected. A 78-year-old resident last vomited at 0600 today; it is now 1400, and the resident asks to eat lunch in the dining room. The resident's roommate has no symptoms. A nursing assistant on the unit reports having had diarrhea overnight. Which actions should the nurse take? Select all that apply. 1 Wear a surgical mask with the gown and gloves while cleaning vomitus off the floor 2 Keep contact precautions for this resident until 48 hours after the last symptoms 3 Let the resident eat in the dining room now that 8 hours have passed without vomiting 4 Tell the nursing assistant to stay off work until 48 hours after the symptoms resolve 5 Use alcohol-based hand rub after removing gloves when leaving the resident's room 6 Move the roommate into another ill resident's room to open a single room for isolation ## Explanation Norovirus shedding continues after symptoms stop, so precautions, group-activity restriction, and staff exclusion all run until at least 48 hours after symptoms resolve; 8 symptom-free hours is not enough. Masks are advised when vomitus may splash. During a norovirus outbreak, soap-and-water hand hygiene is preferred after care, and cohorting means grouping ill residents together, never placing a well roommate with an ill one. ## In-depth explanation Quick answer Mask for vomitus cleanup, keep precautions 48 hours past symptoms, and exclude the ill staff member for 48 hours. Why this is correct The timing details decide this item. The resident has been symptom-free for only 8 hours, and CDC guidance keeps norovirus precautions (and restriction from group dining) for at least 48 hours after symptoms resolve. The same 48-hour rule applies to the nursing assistant, who is a likely vector for spreading the outbreak. Vomiting aerosolizes virus, so a surgical mask (with eye protection if splashing) is recommended during cleanup in addition to gown and gloves. Easy analogy or mental picture Norovirus is like glitter: the party (symptoms) can be over, but it keeps turning up for days afterward. Memory hook Norovirus: 48 after the last, soap beats rub, cohort the sick, not the well. NCLEX decision rule In an outbreak, base the end of precautions and staff return on time since last symptoms, not on how the client feels now. Why the other choices are wrong Returning to the dining room after 8 hours is tempting because the resident looks well, but it exposes the whole unit before the 48-hour window. Alcohol-based rub is the default for most care, so it feels correct, yet it has limited activity against non-enveloped norovirus and soap and water is preferred in this outbreak. Moving the well roommate in with another ill resident misapplies cohorting; it exposes a susceptible person instead of separating ill from well. References 1CDC — NorovirusNorovirus transmission, hand hygiene with soap and water, and outbreak prevention in health care settings 2CDC — Isolation Precautions guidelineContact precautions and use of masks when splashing is anticipated ## Clinical scenario Scenario Suspected norovirus cluster on a long-term care hallway. Index resident last vomited 8 hours ago and wants group dining; roommate is well; one staff member had diarrhea overnight. ## Key concepts - **Cohorting** — Grouping residents with the same infection together, with dedicated staff and equipment, to limit spread. - **Non-enveloped virus** — A virus without a lipid envelope, such as norovirus, which makes it resistant to alcohol and many disinfectants. - **Staff exclusion** — Keeping ill health care personnel off work for a set period, 48 hours after symptom resolution for norovirus. ## Related questions - [A nurse is caring for a client newly admitted with suspected methicillin-resistant Staphyl…](https://mymerci.kr/pages/nclex_q.php?qn_id=360517&lang=en) - [A nurse is about to enter the room of a client with Clostridioides difficile infection dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=361226&lang=en) - [A 22-year-old female client presents to the emergency department with a 4-week history of …](https://mymerci.kr/pages/nclex_q.php?qn_id=361677&lang=en) - [A 65-year-old client admitted to the medical ICU with sepsis and acute delirium has just p…](https://mymerci.kr/pages/nclex_q.php?qn_id=361679&lang=en) - [A new graduate registered nurse (RN) on a medical unit just hung an intravenous antibiotic…](https://mymerci.kr/pages/nclex_q.php?qn_id=361710&lang=en) - [A nurse is caring for a client newly admitted with active Clostridioides difficile infecti…](https://mymerci.kr/pages/nclex_q.php?qn_id=363996&lang=en) - [A nurse is caring for an adult client newly admitted with suspected active pulmonary tuber…](https://mymerci.kr/pages/nclex_q.php?qn_id=366306&lang=en) - [A nurse cares for a client newly admitted with a positive surveillance culture for vancomy…](https://mymerci.kr/pages/nclex_q.php?qn_id=366709&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617290&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._