Which clients taking penicillin G should the nurse plan to monitor closely?

Question

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

Answer 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.