A nurse is caring for a client who is desiring their wound care to be provided at 1400.
The nurse returns at 1400 to perform wound care for the client.
Which of the following ethical principles is the nurse demonstrating?

The correct answer is B.

Choice A reason: Using a stiff toothbrush to clean the client’s teeth is not recommended. A stiff toothbrush can cause damage to the gums and teeth, especially in clients who may have sensitive oral tissues due to medications or medical treatments.

Choice B reason: Turning the client on his side before starting oral care is the most appropriate action. This is to prevent aspiration, especially in immobile clients who may have difficulty swallowing or clearing their throat.

Choice C reason: Using the thumb and index finger to keep the client’s mouth open is not recommended. This could be uncomfortable or even harmful for the client. Instead, a padded tongue blade could be used if necessary, but only with extreme caution and the client’s comfort in mind.

Choice D reason: Applying petroleum jelly to the client’s lips after oral care is also a good practice. This helps to prevent dryness and cracking of the lips, which can be a common problem for hospitalized patients, especially those who are dehydrated or receiving oxygen therapy. However, when compared to choice B, it is not as critical in terms of immediate safety concerns.

The correct answer is Choice A, Choice B

Choice A rationale: Clostridium difficile is a spore-forming, gram-positive anaerobic bacillus that causes antibiotic-associated colitis. Transmission occurs via the fecal-oral route, primarily through contact with contaminated surfaces or hands. Protective gowns are essential during care to prevent spore transfer to clothing and subsequent environmental contamination. Spores resist alcohol-based sanitizers and persist on surfaces for months. Contact precautions, including gown use, reduce nosocomial spread. Normal white blood cell count is 4,000–11,000/mm³; elevated levels may indicate infection severity.

Choice B rationale: Isolation in a private room is critical for clients with confirmed Clostridium difficile infection due to the organism’s ability to form resilient spores that contaminate surfaces and equipment. Private rooms limit environmental exposure and reduce cross-contamination risk. C. difficile spores are resistant to routine cleaning agents and require bleach-based disinfectants. Diarrheal stool volume increases transmission risk. Normal stool frequency is 1–3 formed stools/day; 4–5 liquid stools/day indicates active infectious diarrhea requiring isolation.

Choice C rationale: N-95 respirators are designed for airborne pathogens such as Mycobacterium tuberculosis, measles virus, or varicella-zoster virus. Clostridium difficile is not airborne; it transmits via contact with contaminated surfaces or hands. Spores are shed in feces and do not aerosolize under normal conditions. Therefore, N-95 respirators offer no added protection against CDI. Airborne precautions are unnecessary unless aerosol-generating procedures are performed on patients with concurrent airborne infections. Respiratory rate normal range is 12–20 breaths/min.

Choice D rationale: Negative pressure rooms are used to contain airborne pathogens by maintaining lower air pressure inside the room, preventing contaminated air from escaping. Clostridium difficile does not spread via airborne particles but through contact with contaminated surfaces and feces. Thus, negative pressure rooms are not scientifically justified for CDI. Instead, contact isolation and environmental decontamination are prioritized. Room air exchanges are irrelevant to CDI control. Normal room air pressure is neutral unless airborne precautions are indicated.

Choice E rationale: Masking the client is a droplet precaution used for pathogens like influenza virus, Neisseria meningitidis, or SARS-CoV-2. Clostridium difficile does not transmit via respiratory droplets, so placing a mask on the client during transport does not reduce transmission risk. Instead, hand hygiene and contact precautions are essential. CDI spores are not expelled via coughing or sneezing. Droplet precautions are reserved for pathogens with particle size >5 µm. Normal oxygen saturation is ≥95% on room air.