# A nurse has just drawn blood from a client whose HIV, hepatitis B, and hepatitis C status is unknown. While the nurse is discarding the needle, the safety device fails to engage and the hollow-bore needle, which has visible blood in its hub, punctures the nurse's gloved index finger. After removing the glove, the nurse sees a small puncture wound with minimal bleeding. The nurse has no other cuts on the hands, and no blood splashed onto the face or eyes. The nurse completed the hepatitis B vaccine series 8 years ago. Complete the diagram by selecting the type of exposure the nurse has most likely experienced, 2 actions the nurse should take to address that exposure, and 2 parameters that should be monitored in the nurse to assess the outcome of the exposure. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=en > language: en > subject: Handling Hazardous/Infectious Materials > category: SIPC ## Question A nurse has just drawn blood from a client whose HIV, hepatitis B, and hepatitis C status is unknown. While the nurse is discarding the needle, the safety device fails to engage and the hollow-bore needle, which has visible blood in its hub, punctures the nurse's gloved index finger. After removing the glove, the nurse sees a small puncture wound with minimal bleeding. The nurse has no other cuts on the hands, and no blood splashed onto the face or eyes. The nurse completed the hepatitis B vaccine series 8 years ago. Complete the diagram by selecting the type of exposure the nurse has most likely experienced, 2 actions the nurse should take to address that exposure, and 2 parameters that should be monitored in the nurse to assess the outcome of the exposure. Condition Select 1 Glove-surface contamination without skin penetration Mucous membrane splash exposure to blood Percutaneous blood exposure from a used needle Low-risk injury from an unused, sterile needle Actions to take Select 2 Milk the puncture site to express blood from the wound Wash the puncture site with soap and water Wait for the source client's results before reporting Report the exposure now for same-day evaluation Draw the source client's blood for testing personally Parameters to monitor Select 2 Tuberculin skin test result at baseline and 8 to 10 weeks HIV antigen/antibody test at baseline and follow-up Redness and warmth at the puncture site Daily oral temperature for 1 week Hepatitis C antibody or RNA at baseline and follow-up ## Explanation A used hollow-bore needle with visible blood that punctures the skin is a high-risk percutaneous exposure. The nurse washes the site with soap and water and reports immediately so source testing and HIV PEP can begin within hours if indicated. Progress is judged by baseline and follow-up HIV and hepatitis C testing. ## In-depth explanation Quick answer Percutaneous blood exposure from a used hollow-bore needle; wash with soap and water and report now for same-day evaluation; monitor HIV and hepatitis C test results at baseline and follow-up. Why this is correct The glove did not prevent penetration, the needle had just been used for venipuncture, and blood was visible in the hub, so this is a percutaneous exposure to blood rather than surface contamination or a sterile-needle injury. Hollow-bore needles carry the highest transmission risk. Washing removes surface contamination, and prompt reporting lets the employee-health or emergency team arrange source testing and start HIV postexposure prophylaxis, ideally within hours. Easy analogy or mental picture Think of the needle as a tiny syringe that delivered a droplet of the client's blood under the skin. The goal now is to rinse the entry point and start the PEP clock, then check later whether any infection took hold. Memory hook "Wash, Report, Test" — soap and water, same-day report, baseline and follow-up labs. NCLEX decision rule After a percutaneous blood exposure, choose gentle soap-and-water cleansing and immediate reporting; choose monitoring that detects seroconversion to the bloodborne pathogens involved. Why the other choices are wrong Milking or squeezing the wound was once taught but adds tissue trauma without proven benefit. Waiting for source results delays PEP, which works best when started within hours. The exposed nurse should not personally draw the source client's blood; source testing is arranged through the exposure protocol with consent. Glove contamination, mucous-membrane splash, and sterile-needle injury are ruled out by the skin puncture, the absence of splash, and visible blood in a used needle. Tuberculin testing tracks airborne TB exposure, and local redness or temperature checks detect a wound infection, not bloodborne-pathogen transmission. References 1CDC — Occupational HIV Transmission and Prevention Among Health Care WorkersWash needlestick sites with soap and water, report immediately, start PEP as soon as possible when indicated, and complete follow-up HIV testing. ## Clinical scenario Scenario A used, blood-filled hollow-bore needle penetrated the nurse's skin through the glove; the source client's bloodborne-pathogen status is unknown. ## Key concepts - **Hollow-bore needle** — A needle with a lumen that can carry blood, making exposures more likely to transmit bloodborne pathogens than solid needles. - **Postexposure prophylaxis (PEP)** — A short course of antiretroviral drugs started as soon as possible after a high-risk HIV exposure to prevent infection. - **Seroconversion** — The development of detectable antibodies or antigen showing that an infection has taken hold. ## Related questions - [A nurse cares for a client receiving brachytherapy with an internal radiation implant (ces…](https://mymerci.kr/pages/nclex_q.php?qn_id=366657&lang=en) - [A nurse is preparing to administer IV doxorubicin (a vesicant chemotherapy agent) to a cli…](https://mymerci.kr/pages/nclex_q.php?qn_id=368108&lang=en) - [For each action involving an antineoplastic hazardous drug, identify whether it reduces oc…](https://mymerci.kr/pages/nclex_q.php?qn_id=547049&lang=en) - [While a client receives an intravenous cyclophosphamide infusion, a loose tubing connectio…](https://mymerci.kr/pages/nclex_q.php?qn_id=617292&lang=en) - [During a cyclophosphamide infusion in an outpatient infusion center, the IV tubing separat…](https://mymerci.kr/pages/nclex_q.php?qn_id=617416&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617428&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._