During a cyclophosphamide infusion in an outpatient infusion center, the IV tubing separates at the Y-site. About 50 mL of clear infusate spreads across the floor, and the stream strikes the nurse's right sleeve below the elbow and soaks through the disposable gown; the forearm skin under the sleeve is wet. The nurse is wearing one pair of examination gloves and a face shield. Two visitors begin walking toward the area. A hazardous-drug spill kit, chemotherapy-tested gloves, and the facility exposure procedure are available. Complete the diagram by selecting the situation the nurse is most likely experiencing, 2 actions the nurse should take to address that situation, and 2 parameters to monitor to assess the exposed nurse's progress.

Quick answer
Hazardous-drug skin exposure with an active spill. Take off the wet gown and wash the skin with soap and water, and restrict the area so trained staff can use the spill kit. Monitor skin redness at the contact site and reported burning or itching of the forearm.

Why this is correct
Cyclophosphamide is an antineoplastic hazardous drug. The data that decide the answer are specific: the drug soaked through the sleeve onto skin (so this is more than gown contamination), about 50 mL is spreading across the floor (far beyond a small spill), and the stream hit the sleeve while a face shield covered the eyes. Removing the wet gown and washing with soap and water limits skin absorption. Restricting access and having trained staff use the spill kit stops the drug from spreading to visitors and other staff. The skin at the contact site is where injury from this exposure would show.

Easy analogy or mental picture
Think of a paint spill: first get the paint off your skin with soap and water, then fence off the wet floor so no one tracks it around, then keep checking the skin where the paint landed.

Memory hook
Skin: strip and wash. Floor: fence and kit. Follow-up: the skin that got wet.

NCLEX decision rule
When a hazardous drug contacts skin, decontaminate the person with soap and water and contain the spill with trained staff and the kit, then report the exposure promptly. Monitor the tissue the exposure can damage.

Why the other choices are wrong
Gown-only contamination is tempting, but the skin under the sleeve is wet, so the drug has reached the skin. A small spill can be wiped up with routine supplies, but 50 mL spreading on the floor needs the spill kit and restricted access; paper towels and routine cleaner spread the drug. An eye splash would call for irrigation and visual acuity checks, but the stream hit the sleeve and a face shield covered the eyes. Alcohol-based hand rub does not remove drug residue and can increase skin absorption. The exposure is reported promptly to employee health, not held until the shift ends. Peak flow would track an inhalation injury, and hematuria reflects systemic cyclophosphamide toxicity at treatment doses, not brief skin contact that was washed off.