A nurse is scheduling a client for surgery.
Which of the following actions should the nurse take to obtain precertification for the client to have surgery?

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.

The correct answer is: A

Choice A reason: Providing the nurse administering medications with an identifying vest can help reduce medication errors by making it easier for other staff and patients to identify the nurse responsible for medication administration. This can minimize interruptions and distractions, which are common causes of medication errors. It also serves as a visual reminder to the nurse of their critical role in medication safety.

Choice B reason: Removing medications from automatic dispensing systems before they are reviewed by pharmacists is not a recommended practice. Pharmacists play a crucial role in reviewing prescriptions for accuracy and potential drug interactions before dispensing. Therefore, medications should remain in the dispensing system until they have been properly reviewed and approved by a pharmacist.

Choice C reason: Waiting to document medications given to clients until the end of a shift is not advisable. Accurate and timely documentation is essential in healthcare, particularly when it comes to medication administration. Documentation should occur as soon as the medication is given to ensure that all healthcare providers have up-to-date information and to prevent errors such as omissions or duplications.

Choice D reason: Preparing medications for multiple clients at the same time increases the risk of errors, such as mix-ups between patients or incorrect dosing. It is best practice to prepare and administer medications for one client at a time, following the ‘five rights’ of medication administration: the right patient, the right drug, the right dose, the right route, and the right time.