Which clients taking penicillin G should the nurse plan to ...

[hubes95]

Which clients taking penicillin G should the nurse plan to monitor closely?
 
  Standard Text: Select all that apply.
  1. A client with diabetes
  2. A client with heart failure
  3. A client taking spironolactone for hormonal acne
  4. A client taking oral contraceptives
  5. A client with pharyngitis

Question 2

A client asks why the health care provider ordered penicillin for the client's infection. How should the nurse respond?
 
  Standard Text: Select all that apply.
  1. Your infection was caused by gram-positive bacteria.
  2. Penicillin is a narrow-spectrum antibiotic that can be used when the bacteria causing the infection is known.
  3. Penicillins are widely distributed to most body tissues.
  4. Penicillins are slowly excreted by the kidneys. This allows for less frequent dosing.
  5. If you're allergic to penicillin, we can give you a smaller dose to avoid a reaction.

[Brummell1998]

Answer to Question 1

Correct Answer: 1,2,3
Rationale 1: Renal impairment can affect the kidneys' ability to excrete penicillin G.
Rationale 2: Hyperkalemia can result in clients with heart failure who take penicillin G.
Rationale 3: Potassium-sparing diuretics may cause hyperkalemia when taken with penicillin G.
Rationale 4: Clients taking oral contraceptives and penicillin should be told the combination may decrease the effectiveness of the birth control and that using an extra form of birth control such as condoms should be considered.
Rationale 5: There would be no need to closely monitor a client taking penicillin G for pharyngitis unless the client has renal disease, heart failure, or has had a previous allergic response to a cephalosporin.
Global Rationale: Because 90 of a dose of penicillin G is excreted unchanged by the kidneys through tubular secretion, patients with significant renal impairment must be carefully monitored. Patients with heart failure should not receive the penicillin sodium salt. Hyperkalemia may result with high doses of the penicillin G potassium salt. Penicillin G may decrease the effectiveness of oral contraceptives.

Answer to Question 2

Correct Answer: 1,2,3
Rationale 1: Most penicillins are effective against gram-positive bacteria.
Rationale 2: Most penicillins have a narrow spectrum of antimicrobial activity.
Rationale 3: Penicillins are widely distributed to most body tissues, but only small amounts reach the CSF.
Rationale 4: Nearly all penicillins are rapidly excreted by the kidneys.
Rationale 5: Even a small dose of penicillin can elicit an allergic reaction in a susceptible client.
Global Rationale: Although each drug in this class has certain unique properties, some generalizations may be made about the penicillins: most are more effective against gram-positive bacteria, although a few have activity against gram-negative bacteria; most have a narrow spectrum of antimicrobial activity; they are widely distributed to most body tissues, although only small amounts reach the cerebrospinal fluid (CSF); nearly all are rapidly excreted by the kidneys; most have short half-lives. Allergic reactions are the most common adverse effects of the penicillins and ones that require careful attention by nurses.

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