At 2200 a nurse removes an IV catheter from a client who has known HIV infection with a detectable viral load. Blood drips onto the back of the nurse's hand above the glove cuff. The skin in that area has no cuts, abrasions, or dermatitis, and no blood reached the eyes, nose, or mouth. There was no needlestick. Which action should the nurse take?

Quick answer
Wash the skin with soap and water and file an exposure report.

Why this is correct
The source has HIV with a detectable viral load, which pushes a keyword-matcher toward PEP, but the route decides the risk. The blood touched only skin that has no cuts, abrasions, or dermatitis, with no needlestick and no mucous membrane contact. Intact skin blocks HIV, so PEP is not indicated. Washing removes the blood, and the report documents the event and allows an evaluator to confirm the exposure type.

Easy analogy or mental picture
Intact skin is a raincoat: blood on the outside of the raincoat does not reach you. A needle hole or a splash in the eye is a tear in the raincoat.

Memory hook
Needle or mucous membrane + HIV source = PEP now. Intact skin = wash and report.

NCLEX decision rule
For any bloodborne exposure, classify the route first (percutaneous, mucous membrane, nonintact skin, or intact skin) and then decide on PEP; the source's status matters only for a route that can transmit.

Why the other choices are wrong
Going to the ED for PEP within hours is exactly right after a needlestick from this source, and the known detectable viral load makes it very tempting, but there was no puncture and the skin was intact. Flushing with water for 15 minutes and then seeking evaluation is the correct response to a splash into the eyes, nose, or mouth, which the stem rules out. Rapid HIV testing of the source is used when the source's status is unknown after a qualifying exposure; here the status is already known and the exposure does not qualify.