A patient is receiving intravenous potassium penicillin G, 2 ...

[SGallaher96]

A patient is receiving intravenous potassium penicillin G, 2 million units to be administered over 1 hour. At 1900, the nurse notes that the dose hung at 1830 has infused completely. What will the nurse do?
 
  a. Assess the skin at the infusion site for signs of tissue necrosis.
  b. Observe the patient closely for confusion and other neurotoxic effects.
  c. Request an order for serum electrolytes and cardiac monitoring.
  d. Watch the patient's actions and report any bizarre behaviors.

Question 2

A patient has an infection caused by Pseudomonas aeruginosa. The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do?
 
  a. Make sure to administer the drugs at different times using different IV tubing.
  b. Suggest giving larger doses of piperacillin and discontinuing the amikacin.
  c. Suggest that a fixed-dose combination of piperacillin and tazobactam (Zosyn) be used.
  d. Watch the patient closely for allergic reactions, because this risk is increased with this combination.

[srodz]

Answer to Question 1

ANS: C
Although penicillin G is the least toxic of all antibiotics, certain adverse effects may be caused by compounds coadministered with penicillin. When large doses of potassium penicillin G are administered rapidly, hyperkalemia can occur, which can cause fatal dysrhythmias. When penicillin G is administered IM, tissue necrosis occurs with inadvertent intra-arterial injection. Confusion, seizures, and hallucinations can occur if blood levels of the drug are too high. Bizarre behaviors result with large IV doses of procaine penicillin G.

Answer to Question 2

ANS: A
When penicillins are present in high concentrations, they interact with aminoglycosides and inactivate the aminoglycoside; therefore, these two drugs should never be mixed in the same IV solution. The drugs should be given at different times with different tubing. In the treatment of Pseudomonas infections, extended-spectrum penicillins, such as piperacillin, usually are given in conjunction with an antipseudomonal aminoglycoside, such as amikacin; therefore, suggesting a larger dose of piperacillin and discontinuation of the amikacin is incorrect. Zosyn is not recommended. The risk of allergic reactions does not increase with this combination of drugs.