# 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.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617416&lang=en  
> language: en  
> subject: Handling Hazardous/Infectious Materials  
> category: SIPC

## Question

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.

Condition

Select 1
Gown contamination without skin contact
Small spill that is manageable with routine cleaning
Hazardous-drug skin exposure with an active spill
Hazardous-drug splash exposure to the eyes

Actions to take

Select 2
Clean the wet forearm skin with an alcohol-based hand rub
Remove the wet gown and wash skin with soap and water
Wipe up the spill with paper towels and cleaner
Restrict access so trained staff can use the spill kit
File the exposure report after the shift ends

Parameters to monitor

Select 2
Visual acuity in both eyes
Skin redness at the contact site
Peak expiratory flow rate
Reported burning or itching of the forearm
Urine dipstick for blood during the next week

## Explanation

Cyclophosphamide soaking through the gown onto the forearm, with about 50 mL spreading across the floor, is a hazardous-drug skin exposure with an active spill. The exposed nurse removes the contaminated gown and washes with soap and water, and the area is restricted so trained staff can clean it with the spill kit; the exposure is then reported promptly to employee health. Redness and burning or itching at the contact site show whether skin injury is developing.

## In-depth explanation

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.

References
1NIOSH — Managing Hazardous Drug Exposures: Information for Healthcare SettingsSpill response, PPE, skin decontamination, and reporting of hazardous-drug exposures
2OSHA — Hazardous DrugsWorker protection and exposure procedures for hazardous drugs

## Clinical scenario

Scenario
A cyclophosphamide line separated, about 50 mL spread on the floor, and the drug soaked through the nurse's sleeve onto the forearm while the nurse wore a face shield.

## Key concepts

- **Hazardous drug** — A drug, such as many antineoplastics, that can cause cancer, reproductive or developmental harm, or organ toxicity in workers who are exposed to it.
- **Spill kit** — A prepared set of chemotherapy-tested gloves, gown, eye and respiratory protection, absorbent pads, and labeled waste bags used to contain a hazardous-drug spill.
- **Skin decontamination** — Removing contaminated clothing and washing exposed skin with soap and water to limit absorption of a hazardous drug.

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