Which client should be most closely monitored for adverse effects directly related to receiving penicillin G?
1. A client who has osteomyelitis and will need IV medication for several months
2. A client who had a myocardial infarction 2 days ago and now has a fever of 102°F
3. A client who is postop from corneal transplant
4. A client who has diabetes and is on dialysis
Correct Answer: 4
Rationale 1: Clients with osteomyelitis may receive several broad-spectrum antibiotics.
Rationale 2: This patient would be monitored for development of heart failure which is a contraindication to penicillin G, but this is not the correct answer as there is no indication that heart failure exists.
Rationale 3: Corneal transplant is not an indication for caution with penicillin.
Rationale 4: Clients with significant renal impairment must be monitored closely while on penicillin.
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.
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