# While a client receives an intravenous cyclophosphamide infusion, a loose tubing connection leaks about 10 mL of the solution onto the floor beside the bed. The nurse is trained in hazardous drug handling, and the unit's hazardous drug spill kit is in the hallway. No drug reached the client's skin, the linens, or the nurse. After clamping the tubing, which actions should the nurse take? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617292&lang=en  
> language: en  
> subject: Handling Hazardous/Infectious Materials  
> category: SIPC

## Question

While a client receives an intravenous cyclophosphamide infusion, a loose tubing connection leaks about 10 mL of the solution onto the floor beside the bed. The nurse is trained in hazardous drug handling, and the unit's hazardous drug spill kit is in the hallway. No drug reached the client's skin, the linens, or the nurse. After clamping the tubing, which actions should the nurse take? Select all that apply.

1

Wear eye and face protection because liquid may splash while the spill is cleaned

2

Skip the incident report because no person's skin or eyes were contaminated

3

Absorb the liquid with the kit's pads, working from the outer edge toward the center

4

Put on two pairs of chemotherapy-tested gloves and an impermeable gown from the kit

5

Rely on a surgical mask for respiratory protection while cleaning up the liquid

6

Spray bleach disinfectant on the puddle first so the drug is inactivated before wiping

## Explanation

A small hazardous drug spill is cleaned promptly by trained staff with the spill kit: double chemotherapy-tested gloves, an impermeable gown, and eye/face protection, then absorbing the liquid from the edge inward. Spraying a deactivating agent before absorbing can aerosolize the drug, a surgical mask gives no respiratory protection against hazardous drug aerosols, and every hazardous drug spill is documented and reported even when no one was exposed.

## In-depth explanation

Quick answer
Don double chemo gloves, gown, and eye/face protection, absorb from the outside in, and report the spill.

Why this is correct
Because the nurse is trained, the kit is at hand, and the volume is small, this is a contained spill managed at the bedside. USP 800 and OSHA guidance call for full protective equipment from the kit and absorbing liquid with pads before any deactivation or cleaning, working from the least to the most contaminated area so the spill is not pushed outward. Spills are documented so the facility can track hazardous drug events, whether or not a person was exposed.

Easy analogy or mental picture
Treat the puddle like spilled ink on a table: blot it up from the edges inward, never spray it first.

Memory hook
Kit, cover, blot in, write it up.

NCLEX decision rule
For a hazardous drug spill, protect yourself with spill-kit PPE, contain and absorb before cleaning, and report every spill.

Why the other choices are wrong
Spraying bleach sounds protective because deactivating agents are part of cleanup, but they are applied only after the liquid is absorbed; spraying first can aerosolize the drug. Skipping the report is tempting because the scenario emphasizes that no one was contaminated and exposure reports are what many staff remember, yet the spill itself must be documented. A surgical mask looks like respiratory protection, but it does not filter hazardous drug aerosols; a fit-tested respirator is used when respiratory protection is needed.

References
1OSHA — Hazardous DrugsWorker protection, PPE, and spill management for hazardous drugs
2USP General Chapter <800> Hazardous Drugs—Handling in Healthcare SettingsSpill management with trained personnel, spill kits, and required PPE

## Clinical scenario

Scenario
Small (about 10 mL) cyclophosphamide spill on the floor from a leaking IV connection. Trained nurse, spill kit available, no one contaminated.

## Key concepts

- **Hazardous drug** — A drug, such as many antineoplastics, that is carcinogenic, teratogenic, or toxic to workers at low doses.
- **Chemotherapy-tested gloves** — Gloves tested to ASTM D6978 for resistance to permeation by chemotherapy drugs.
- **Spill kit** — A prepackaged set of PPE, absorbent pads, scoop, and labeled waste bags for hazardous drug spills.

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