NCLEX Practice Exam for Pharmacology: Respiratory Medications

EXPLANATION

✔Correct answer:

Cola and chocolate. Theophylline is a bronchodilator commonly used to treat respiratory diseases like asthma and chronic obstructive pulmonary disease (COPD). It has a narrow therapeutic index, meaning that maintaining the correct blood concentration of the drug is crucial to avoid toxicity. Nurse Samantha should instruct the patient to limit the intake of cola, chocolate, and other caffeine-containing products. Caffeine and theophylline are both methylxanthines, and consuming these substances together can increase the risk of theophylline toxicity by potentiating its effects, leading to symptoms such as nausea, vomiting, palpitations, and even seizures in severe cases.

Theophylline and caffeine are metabolized by the liver through the cytochrome P450 enzyme system, specifically CYP1A2. Caffeine, present in cola, chocolate, coffee, and other beverages, competes with theophylline for metabolism in the liver. This competition can lead to increased levels of theophylline in the blood, raising the risk of toxicity. The combination of theophylline and other methylxanthines like caffeine can also enhance central nervous system stimulation and cardiovascular effects, such as tachycardia and arrhythmias.

Imagine theophylline and caffeine as cars trying to merge onto the same highway (your liver's enzyme system). If too many cars try to merge at once, traffic (drug levels) backs up, leading to congestion (toxicity).

Nurse Samantha should educate the patient to limit or avoid foods and beverages containing caffeine while taking theophylline. She should also inform the patient about the signs of theophylline toxicity and advise them to seek medical attention if they experience symptoms such as nausea, restlessness, or palpitations.

• Advise the patient to limit the intake of caffeine-containing products such as cola, chocolate, coffee, and tea.
• Educate the patient on recognizing early signs of theophylline toxicity, including gastrointestinal distress, nervousness, and palpitations.
• Encourage the patient to maintain regular follow-up appointments to monitor theophylline levels in the blood.
• Review the patient's medication and dietary habits to ensure that other sources of methylxanthines are minimized.

✘Incorrect answer options:

Yogurt and cheese. Dairy products like yogurt and cheese do not contain substances that interact with theophylline metabolism. Therefore, they do not pose a risk for theophylline toxicity.

Tuna and oysters. Seafood such as tuna and oysters do not contain caffeine or other methylxanthines that would interact with theophylline. These foods do not need to be limited in patients taking theophylline.

Apple and banana. Fruits like apples and bananas are safe to consume while taking theophylline. They do not interfere with the drug’s metabolism and do not increase the risk of toxicity.

EXPLANATION

✔Correct answer:

Wheezing. Cromolyn sodium (Intal) is a mast cell stabilizer used as a prophylactic treatment to prevent asthma symptoms. It works by inhibiting the release of histamine and other inflammatory mediators from mast cells, which helps to prevent bronchoconstriction and inflammation. However, one of the possible side effects of Cromolyn sodium is paradoxical bronchospasm, which can lead to wheezing immediately after inhalation. This is an unexpected and potentially serious side effect where the airways constrict instead of dilating, causing respiratory symptoms similar to those it is intended to prevent.

Cromolyn sodium stabilizes the mast cells in the respiratory tract, preventing them from releasing substances that cause inflammation and bronchoconstriction. Although generally well-tolerated, in some patients, the inhalation of Cromolyn sodium can trigger a reflex bronchospasm, which manifests as wheezing, coughing, and difficulty breathing. This paradoxical reaction is thought to be due to an irritant effect of the drug on the bronchial mucosa or a hypersensitivity response in susceptible individuals.

Taking Cromolyn sodium is like installing a security system (mast cell stabilizer) in your house to prevent break-ins (asthma attacks). However, sometimes the system can malfunction and trigger an alarm (wheezing), even when there’s no real threat.

Nurse Carla should educate the patient on recognizing signs of paradoxical bronchospasm, such as increased wheezing or shortness of breath after using the inhaler. The patient should be advised to stop using the inhaler and seek medical attention immediately if this occurs. Additionally, Nurse Carla should inform the patient that they should use a bronchodilator as directed by their healthcare provider if they experience such symptoms.

• Instruct the patient to monitor for any increase in wheezing or breathing difficulty after using the inhaler.
• Advise the patient to use a bronchodilator if wheezing occurs and to seek medical help immediately.
• Reassure the patient that while this side effect is possible, it is not common, and Cromolyn sodium is generally safe and effective for long-term asthma management.

✘Incorrect answer options:

Hypotension. Cromolyn sodium does not typically cause systemic side effects like hypotension because it acts locally in the lungs with minimal systemic absorption. Hypotension is more commonly associated with systemic medications or those that affect the cardiovascular system.

Difficulty sleeping. Cromolyn sodium is not known to cause difficulty sleeping (insomnia). This side effect is more commonly associated with medications that have stimulant properties or those that affect the central nervous system, such as certain bronchodilators like albuterol.

Constipation. Constipation is not a known side effect of Cromolyn sodium. This symptom is typically associated with medications that affect the gastrointestinal system, such as opioids, anticholinergics, or certain antacids.

EXPLANATION

✔Correct answer:

Difficulty distinguishing the color red from green. Ethambutol (Myambutol) is an antimycobacterial medication commonly used in the treatment of tuberculosis. A well-known adverse effect of Ethambutol is optic neuritis, which can lead to visual disturbances. One of the hallmark symptoms of optic neuritis induced by Ethambutol is difficulty distinguishing between red and green colors. This condition can progress to more severe visual impairment if not detected early and managed appropriately, which may involve discontinuing the medication.

Ethambutol is known to cause dose-dependent optic neuropathy, potentially leading to optic neuritis. The optic nerve, which transmits visual information from the retina to the brain, can be damaged by Ethambutol, resulting in symptoms such as reduced visual acuity and color blindness, particularly red-green color discrimination. This occurs because the medication affects the retinal ganglion cells and their axons in the optic nerve. If optic neuritis is suspected, it is critical to stop the medication to prevent permanent visual damage.

Think of the optic nerve as a cable that carries signals (visual information) from your eyes to your brain. Ethambutol can cause this cable to fray, leading to faulty signal transmission, which might first show up as difficulty in telling red from green.

Nurse Rachel should immediately report any signs of visual disturbances, particularly color blindness, to the healthcare provider. The patient may need to discontinue Ethambutol and switch to an alternative medication. Regular ophthalmologic examinations should be conducted to monitor the patient’s vision during Ethambutol therapy.

• Monitor the patient for any signs of visual disturbances, particularly difficulty distinguishing colors.
• Report any symptoms of optic neuritis to the healthcare provider immediately.
• Ensure the patient has regular ophthalmologic exams while on Ethambutol therapy to detect any early signs of optic nerve damage.
• Educate the patient on the importance of reporting any changes in vision as soon as they occur.

✘Incorrect answer options:

Damaged hearing. Hearing damage, particularly ototoxicity, is more commonly associated with aminoglycosides like streptomycin rather than Ethambutol. Ethambutol does not typically cause hearing loss or other auditory issues.

Loss of balance. Loss of balance is also more commonly associated with medications that affect the vestibular system, such as aminoglycosides, rather than with Ethambutol. Ethambutol’s side effects are primarily related to vision, not balance.

Red-orange colored bodily secretions. Red-orange discoloration of bodily fluids, such as urine, sweat, and tears, is a well-known side effect of Rifampin, not Ethambutol. Ethambutol does not cause this type of discoloration.

EXPLANATION

✔Correct answer:

An allergy to peanuts. Ipratropium (Combivent) is a combination medication that contains both Ipratropium bromide and Albuterol, which are used to manage symptoms in patients with chronic obstructive pulmonary disease (COPD). Historically, some formulations of Ipratropium inhalers used soya lecithin as a propellant, which is related to peanuts. Patients with a peanut allergy could have a severe allergic reaction (anaphylaxis) if they used these inhalers. Although modern formulations may no longer contain this ingredient, the concern remains, and it is critical to confirm that the patient does not have a peanut allergy before administering the medication.

An allergy to peanuts involves an immune response where the body mistakenly identifies peanut proteins as harmful. This can lead to the release of histamines and other chemicals from mast cells, causing symptoms that can range from mild (such as hives) to severe (anaphylaxis), characterized by airway constriction, hypotension, and potentially fatal outcomes. Given that some inhaler formulations have used ingredients derived from peanuts, using such medications in allergic patients could trigger a life-threatening reaction.

Prescribing an inhaler containing ingredients related to peanuts for someone with a peanut allergy is like sending someone allergic to bees into a room full of beehives—it's a potentially dangerous situation that could trigger a severe reaction.

Nurse Karen should immediately contact the prescribing provider to discuss the patient’s peanut allergy and consider an alternative medication. It’s crucial to avoid any risk of allergic reaction by ensuring the medication is safe for the patient to use. Additionally, she should educate the patient about the importance of reporting all allergies to healthcare providers and reviewing medication labels carefully.

• Verify with the healthcare provider whether the specific formulation of Ipratropium prescribed is safe for a patient with a peanut allergy.
• Consider alternative bronchodilators that do not have a risk of cross-reactivity with peanut allergies.
• Educate the patient about potential signs of an allergic reaction and ensure they know how to seek emergency care if symptoms occur.
• Update the patient’s allergy history in their medical records to prevent similar issues in the future.

✘Incorrect answer options:

A previous infection. A history of a previous infection does not pose a contraindication to using Ipratropium. COPD patients often have a history of respiratory infections, but these do not interfere with the use of Ipratropium.

A history of smoking. A history of smoking is common in patients with COPD, and it is often a contributing factor to the development of the disease. However, this history does not contraindicate the use of Ipratropium, which is frequently prescribed to help manage COPD symptoms.

An allergy to eggs. An egg allergy is not related to the use of Ipratropium or its formulations. Egg allergies are more commonly a concern with vaccines, such as certain influenza vaccines, rather than with inhaled medications like Ipratropium.

EXPLANATION

✔Correct answer:

It enhances the effect of allopurinol. The statement "It enhances the effect of allopurinol" is NOT accurate regarding Pyrazinamide. Pyrazinamide is an antitubercular drug used in combination with other medications to treat tuberculosis. However, it does not enhance the effect of allopurinol, a medication commonly used to treat gout by reducing uric acid levels. In fact, Pyrazinamide can increase uric acid levels, potentially worsening gout, which may necessitate the use of allopurinol. Therefore, rather than enhancing the effect of allopurinol, Pyrazinamide may increase the need for it due to its hyperuricemic effect.

Pyrazinamide is known to inhibit the renal excretion of uric acid, leading to hyperuricemia. Elevated uric acid levels can result in gouty arthritis, especially in predisposed individuals. This is why patients taking Pyrazinamide may require closer monitoring of their uric acid levels and may need treatment with medications like allopurinol to manage or prevent gout. However, Pyrazinamide does not enhance the action of allopurinol; instead, the two medications might be used together to manage the side effects of Pyrazinamide.

Think of Pyrazinamide as adding more wood to a fire (increasing uric acid levels), while allopurinol is like a fire extinguisher trying to put it out (reduce uric acid). Pyrazinamide doesn't make the fire extinguisher more effective; it might just make the fire bigger, requiring more use of the extinguisher.

Nurse Claire should educate the patient about the potential side effects of Pyrazinamide, including its ability to raise uric acid levels. The patient should be informed to report any signs of gout, such as joint pain and swelling, and should be monitored regularly if they have a history of gout. If necessary, allopurinol or other treatments may be prescribed to manage hyperuricemia.

• Educate the patient about the risk of increased uric acid levels and the potential for gout while taking Pyrazinamide.
• Instruct the patient to report any symptoms of gout, such as sudden severe joint pain, redness, or swelling.
• Advise the patient on the importance of regular follow-up appointments to monitor uric acid levels.
• Clarify that Pyrazinamide does not enhance the effect of allopurinol but may increase the need for it.

✘Incorrect answer options:

Photosensitivity is one of the side effects. This statement is accurate. Pyrazinamide can cause photosensitivity, making the skin more susceptible to sunburn. Patients should be advised to use sunscreen, wear protective clothing, and avoid prolonged sun exposure while taking this medication.

Take the medication with food. This statement is accurate. Pyrazinamide can cause gastrointestinal upset, so it is recommended that the medication be taken with food to minimize this side effect.

Use with caution in patients with diabetes mellitus. This statement is accurate. Pyrazinamide can interfere with glucose metabolism and may worsen glycemic control in patients with diabetes mellitus. Therefore, blood glucose levels should be closely monitored in diabetic patients taking this medication.

EXPLANATION

✔Correct answer:

Increase fluid intake while on this medication. Guaifenesin (Mucinex) is an expectorant used to help loosen and thin mucus in the airways, making it easier for the patient to cough up and expel mucus. For Guaifenesin to be most effective, it is essential for the patient to increase their fluid intake. Adequate hydration helps thin the mucus naturally, which works in synergy with the medication to facilitate the clearing of congestion. Therefore, the correct understanding of medication use is to increase fluid intake.

Guaifenesin works by reducing the viscosity of bronchial secretions. The mechanism of action involves hydrating the respiratory tract, which decreases the thickness and stickiness of mucus, allowing it to be more easily cleared by coughing. Increased fluid intake supports this process by further hydrating the mucous membranes, promoting the thinning of secretions, and enhancing the effectiveness of Guaifenesin.

Taking Guaifenesin is like using a plunger to clear a clogged drain. Drinking more fluids is like adding water to help loosen the clog, making it easier for the plunger to work effectively.

Nurse Alex should emphasize the importance of adequate hydration while taking Guaifenesin. The patient should be advised to drink at least 6-8 glasses of water a day, unless contraindicated by another health condition, to maximize the medication's effectiveness.

• Encourage the patient to maintain or increase their fluid intake while taking Guaifenesin.
• Explain that the medication will be more effective in thinning mucus with proper hydration.
• Instruct the patient to continue monitoring their symptoms and seek medical advice if symptoms persist despite medication use.

✘Incorrect answer options:

Take an extra dose if the fever and cough continue. Taking an extra dose of Guaifenesin is not recommended, as it could lead to potential side effects such as nausea, vomiting, or kidney stones. If symptoms persist, the patient should consult with a healthcare provider rather than self-adjusting the dosage.

Only take the medication with meals. Guaifenesin does not need to be taken with meals. It can be taken with or without food, as directed by the prescribing information. This option does not improve the medication's efficacy and is unnecessary for the proper administration of Guaifenesin.

Reduce the amount of fluids consumed. Reducing fluid intake is counterproductive when taking Guaifenesin. This approach could lead to thicker mucus and a less effective response to the medication, making it more difficult for the patient to clear congestion.

EXPLANATION

✔Correct answer:

Peripheral neuritis. The numbness and tingling in the extremities that the patient is experiencing are classic symptoms of peripheral neuritis, also known as peripheral neuropathy. Peripheral neuritis is a known side effect of isoniazid (INH), which is used to treat and prevent tuberculosis. INH interferes with the metabolism of pyridoxine (Vitamin B6), leading to a deficiency that can cause nerve damage, particularly in the peripheral nerves. This nerve damage results in symptoms such as numbness, tingling, and burning sensations in the hands and feet.

Isoniazid's interference with Vitamin B6 metabolism leads to a decrease in the availability of this vitamin, which is essential for the proper function of nerves. Pyridoxine is a coenzyme in the synthesis of neurotransmitters like serotonin, dopamine, and gamma-aminobutyric acid (GABA), which are crucial for nerve function. Without adequate Vitamin B6, nerves can become damaged, leading to peripheral neuropathy. This condition is particularly common in patients who do not receive supplemental pyridoxine while on INH therapy.

Think of nerves as electrical wires that transmit signals. Without proper insulation (Vitamin B6), the wires can become damaged, leading to short-circuiting (numbness and tingling) in the extremities.

Nurse Angela should notify the healthcare provider of the patient's symptoms. The patient may need to start or increase their Vitamin B6 supplementation to prevent further nerve damage. It's also important to assess the severity of the symptoms and provide appropriate education and interventions to manage the condition.

• Notify the healthcare provider about the patient's symptoms of peripheral neuritis.
• Ensure the patient is receiving adequate Vitamin B6 (pyridoxine) supplementation as prescribed.
• Educate the patient on the importance of adhering to Vitamin B6 supplementation to prevent and manage peripheral neuropathy.
• Assess the patient’s neurological status regularly and monitor for progression of symptoms.
• Discuss lifestyle modifications, such as avoiding alcohol, which can exacerbate neuropathy.

✘Incorrect answer options:

Guillain-Barré syndrome. Guillain-Barré syndrome is an autoimmune disorder characterized by acute, rapidly progressive muscle weakness and paralysis, often starting in the legs and spreading upwards. It is not associated with isoniazid use and presents differently from the gradual onset of numbness and tingling seen in peripheral neuritis.

Impaired peripheral circulation. Impaired peripheral circulation, often due to conditions like peripheral artery disease, can cause numbness and tingling, but it is typically associated with cold extremities, color changes, and reduced pulses. This condition is unrelated to INH use and Vitamin B6 deficiency.

Hypercalcemia. Hypercalcemia (elevated calcium levels in the blood) can cause neurological symptoms, but it is not related to the use of isoniazid and does not typically present with isolated numbness and tingling in the extremities. Common symptoms of hypercalcemia include nausea, vomiting, abdominal pain, and altered mental status.

EXPLANATION

✔Correct answer:

Administer the Albuterol inhaler first, followed by Budesonide. The correct sequence for administering inhaled medications in a patient with asthma is to use the bronchodilator (Albuterol) first, followed by the corticosteroid (Budesonide). Albuterol is a short-acting beta-agonist (SABA) that works by quickly relaxing the muscles around the airways, leading to bronchodilation. This opens up the airways, allowing for better delivery and absorption of the subsequent inhaled corticosteroid (Budesonide), which helps to reduce inflammation in the airways.

Asthma is characterized by chronic airway inflammation and bronchoconstriction, leading to symptoms such as wheezing, shortness of breath, and coughing. Albuterol, as a bronchodilator, rapidly acts on the beta-2 adrenergic receptors in the bronchial smooth muscle, causing muscle relaxation and airway dilation. This action provides quick relief from bronchoconstriction. By using Albuterol first, the airways are more open, which enhances the distribution of Budesonide, a corticosteroid that reduces airway inflammation over a longer period.

Administering Albuterol before Budesonide is like opening a door (Albuterol) before trying to push a large box through it (Budesonide). If the door is not fully open, it’s much harder to get the box inside effectively.

Nurse Jamie should educate the patient on the importance of the correct order of inhaler use to maximize the effectiveness of the medications. After administering Albuterol, it’s advisable to wait about 1-2 minutes before administering Budesonide to ensure optimal bronchodilation.

• Instruct the patient to shake the Albuterol inhaler well before use.
• Have the patient exhale fully, place the inhaler in their mouth, and inhale deeply while pressing down on the inhaler to deliver the medication.
• Advise the patient to hold their breath for about 10 seconds after inhaling Albuterol to allow the medication to reach deep into the lungs.
• Wait 1-2 minutes, then repeat the process with Budesonide.
• Educate the patient on rinsing their mouth after using Budesonide to reduce the risk of oral thrush, a common side effect of inhaled corticosteroids.

✘Incorrect answer options:

Alternate puffs between the two inhalers, starting with Budesonide. Alternating between the two inhalers is not recommended because the bronchodilation effect of Albuterol needs to fully take place before administering Budesonide. Starting with Budesonide before opening the airways can reduce its effectiveness.

Alternate puffs between the two inhalers, starting with Albuterol. While starting with Albuterol is correct, alternating puffs between the inhalers is not advisable. The patient should take both puffs of Albuterol first, to fully open the airways, before administering Budesonide.

Administer the Budesonide inhaler first, followed by Albuterol. Administering Budesonide first is incorrect because it may not be as effective if the airways are constricted. Albuterol should always be given first to ensure that the airways are open, allowing Budesonide to be distributed effectively in the lungs.

EXPLANATION

✔Correct answer:

ALT and AST levels. Montelukast (Singulair) is a leukotriene receptor antagonist used for the maintenance treatment of asthma and to relieve symptoms of allergic rhinitis. Although Montelukast is generally well-tolerated, there is a potential risk of liver dysfunction, particularly in patients with pre-existing liver conditions or those taking other hepatotoxic medications. Therefore, Nurse Amy should prioritize monitoring liver function tests, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Elevated levels of ALT and AST can indicate liver inflammation or damage, which may necessitate adjusting the dosage or discontinuing the medication.

Montelukast works by blocking the action of leukotrienes, which are inflammatory mediators that contribute to asthma symptoms by causing bronchoconstriction, increased mucus production, and airway inflammation. While effective, Montelukast undergoes extensive hepatic metabolism via the cytochrome P450 system, particularly CYP2C8, CYP2C9, and CYP3A4. This metabolism can potentially impact liver function, making regular monitoring of liver enzymes (ALT and AST) important for detecting early signs of hepatotoxicity.

Monitoring ALT and AST levels while taking Montelukast is like checking the oil in a car's engine. Just as oil levels can indicate how well the engine is running, ALT and AST levels can show how well the liver is functioning during medication use.

Nurse Amy should educate the patient about the importance of regular liver function tests and instruct them to report any signs of liver dysfunction, such as fatigue, jaundice, dark urine, or right upper quadrant abdominal pain. Nurse Amy should also review the patient’s medication history to identify any other drugs that could increase the risk of liver injury.

• Monitor the patient’s ALT and AST levels before starting Montelukast and periodically during treatment.
• Assess for signs and symptoms of liver dysfunction, including jaundice, dark urine, and abdominal pain.
• Educate the patient on the importance of regular follow-up appointments for liver function tests.
• Review the patient’s current medications to identify any that may contribute to liver dysfunction when combined with Montelukast.

✘Incorrect answer options:

Sodium and potassium levels. Monitoring sodium and potassium levels is essential when using medications that affect electrolyte balance, such as diuretics or certain antihypertensives. Montelukast does not typically affect these electrolyte levels, so they are not the primary focus for monitoring in this case.

Calcium levels and platelet count. Montelukast does not have a significant impact on calcium levels or platelet count. These laboratory values are more relevant for monitoring in conditions or treatments related to bone metabolism or blood clotting disorders, respectively.

Complete blood count (CBC). While a CBC is a useful tool for assessing general health and detecting infections or anemia, it is not the primary laboratory test for monitoring Montelukast therapy. The main concern with Montelukast is its potential effect on liver function, making liver enzyme levels (ALT and AST) the priority for monitoring.

EXPLANATION

✔Correct answer:

Triglyceride level. Ethambutol (Myambutol) is an antimycobacterial drug commonly used in combination with other medications to treat tuberculosis (TB). While Ethambutol requires monitoring of certain laboratory values due to its potential side effects, triglyceride levels are **not** typically monitored as part of this drug's routine management. Triglyceride levels are more relevant to the management of lipid disorders or in patients taking medications that affect lipid metabolism, such as statins or corticosteroids.

Ethambutol's primary concerns involve the risk of optic neuritis, hepatotoxicity, and hyperuricemia. The drug can cause visual disturbances due to its effect on the optic nerve, liver dysfunction due to hepatotoxicity, and elevated uric acid levels leading to gout-like symptoms. However, Ethambutol does not have a significant effect on lipid metabolism, and therefore, monitoring triglyceride levels is not necessary when a patient is on this medication.

Think of monitoring tests for Ethambutol like a car's dashboard. You're keeping an eye on the oil (liver function), engine temperature (uric acid level), and fuel level (complete blood count), but you don't need to check the tire pressure (triglyceride level) because it's not affected by this particular 'journey' with Ethambutol.

Nurse David should focus on monitoring the appropriate lab tests, such as liver function tests (LFTs), uric acid levels, and a complete blood count (CBC), while the patient is on Ethambutol therapy. These tests are critical for identifying potential side effects early and ensuring the safe use of the medication.

• Monitor liver function tests (ALT, AST) to detect any signs of hepatotoxicity early in the course of treatment.
• Regularly assess uric acid levels, as Ethambutol can increase these levels and potentially lead to gout.
• Conduct a complete blood count (CBC) to monitor for any blood dyscrasias, which can occur with long-term use of anti-tubercular medications.
• Educate the patient on the importance of reporting any visual disturbances or signs of gout, such as joint pain and swelling.

✘Incorrect answer options:

Liver function test. Liver function tests (LFTs) are important to monitor because Ethambutol, like many anti-tubercular drugs, has the potential to cause hepatotoxicity. Regular monitoring helps detect liver dysfunction early.

Uric acid level. Monitoring uric acid levels is essential because Ethambutol can increase uric acid, leading to hyperuricemia and gout. Patients on Ethambutol are at risk of developing gout-like symptoms, making this test important.

Complete blood count. A complete blood count (CBC) is necessary to monitor for any hematologic side effects that can occur with anti-tubercular therapy, including Ethambutol. Changes in blood counts may indicate bone marrow suppression or other blood-related side effects.

EXPLANATION

✔Correct answer:

Theophylline level of 25 mcg/ml. Theophylline is a bronchodilator used to treat symptoms of asthma, chronic bronchitis, and other lung diseases by relaxing the muscles around the airways and decreasing the lungs' response to irritants. The therapeutic range for theophylline is generally considered to be between 10-20 mcg/ml. Levels above 20 mcg/ml can lead to toxicity, with levels above 25 mcg/ml significantly increasing the risk of serious toxic effects. Symptoms of theophylline toxicity include restlessness, palpitations, nausea, vomiting, seizures, and arrhythmias. Therefore, a theophylline level of 25 mcg/ml would confirm the toxicity in the patient.

Theophylline works by inhibiting phosphodiesterase, leading to an increase in cyclic AMP, which promotes bronchodilation. It also has stimulant effects on the central nervous system and the heart. When theophylline levels exceed the therapeutic range, it can lead to overstimulation of these systems, resulting in symptoms such as tachycardia, palpitations, and restlessness. At high concentrations, theophylline can induce serious cardiovascular and neurological toxicities, including arrhythmias and seizures, due to its narrow therapeutic index.

Imagine theophylline as the gas pedal in a car. Within the therapeutic range (10-20 mcg/ml), it helps the car (body) run smoothly. But pressing the gas pedal too hard (high theophylline levels) can make the car go out of control, leading to dangerous situations like speeding (toxicity symptoms such as palpitations and seizures).

Nurse Lisa should immediately notify the healthcare provider of the theophylline level and the patient's symptoms. The patient may require interventions to reduce the theophylline level, such as dose reduction, stopping the infusion, or administering activated charcoal or other measures to prevent further absorption. Continuous monitoring of cardiac and neurological status is critical.

• Stop the theophylline infusion if ongoing and contact the healthcare provider immediately.
• Monitor the patient's vital signs, particularly heart rate and rhythm, and watch for signs of worsening toxicity.
• Prepare to administer activated charcoal if ordered to reduce further absorption of the drug.
• Provide supportive care, including intravenous fluids and seizure precautions, if indicated.
• Educate the patient on recognizing early signs of toxicity and the importance of regular monitoring if theophylline therapy continues.

✘Incorrect answer options:

Theophylline level of 10 mcg/ml. A level of 10 mcg/ml is within the lower end of the therapeutic range. It is unlikely to cause toxicity symptoms such as restlessness or palpitations.

Theophylline level of 15 mcg/ml. A level of 15 mcg/ml is within the therapeutic range. While patients can still experience side effects at this level, toxicity is not typically associated with this concentration.

Theophylline level of 20 mcg/ml. A level of 20 mcg/ml is at the upper end of the therapeutic range. While it’s near the threshold for potential toxicity, it is not necessarily toxic. However, symptoms should be monitored closely as levels approach or exceed 20 mcg/ml.

EXPLANATION

✔Correct answer:

Resuscitation equipment. Naloxone hydrochloride (Narcan) is an opioid antagonist used to reverse the life-threatening effects of opioid overdose, particularly respiratory depression, which is the primary cause of mortality in such cases. Although Naloxone effectively binds to opioid receptors, displacing the opioid and reversing its effects, its duration of action is shorter than that of most opioids. This discrepancy can result in a situation where the opioid's effects return once the Naloxone wears off, potentially leading to respiratory arrest. Therefore, having resuscitation equipment (e.g., bag-valve-mask, oxygen supply, and advanced airway management tools) at the bedside is critical to manage any emergent respiratory or cardiac issues.

Opioids bind to mu-opioid receptors in the central nervous system, leading to analgesia, sedation, and, at higher doses, respiratory depression. Respiratory depression occurs due to the suppression of the brainstem's respiratory centers, which respond to hypercapnia (high CO₂ levels) and hypoxia (low O₂ levels). Naloxone, by competitively binding to these receptors, rapidly reverses opioid-induced CNS depression. However, due to its shorter half-life compared to many opioids, there is a risk of re-sedation and recurrence of respiratory depression, necessitating the need for immediate access to resuscitation equipment.

Administering Naloxone to a patient who has overdosed on opioids is like restarting a stalled car engine. While you may get the engine running again, you must be prepared with jumper cables (resuscitation equipment) in case the battery dies again.

After administering Naloxone, Nurse Ellen should closely monitor the patient's respiratory and cardiac status, and be ready to use resuscitation equipment if the patient's condition deteriorates. It is also essential to be prepared for possible agitation or combative behavior if the patient suddenly regains consciousness and experiences opioid withdrawal symptoms.

• Continuously monitor the patient's respiratory rate, depth, and oxygen saturation.
• Have resuscitation equipment and oxygen readily available at the bedside.
• Prepare to administer additional doses of Naloxone if the patient re-experiences respiratory depression.
• Be aware of and manage any signs of acute opioid withdrawal.

✘Incorrect answer options:

Nasogastric tube setup. While a nasogastric tube (NGT) may be useful in certain situations, such as gastric lavage in cases of oral drug overdose, it is not a priority for managing opioid overdose with Naloxone. The focus should be on ensuring the patient's airway, breathing, and circulation (ABCs) are supported.

Suction machine. A suction machine is useful for clearing airway secretions, but it is not the priority in this scenario. The most critical concern is the potential for respiratory arrest, requiring resuscitation equipment. Suctioning might be secondary to ensuring that the airway is patent and the patient can be ventilated effectively.

Sterile dressing tray. A sterile dressing tray is unrelated to the immediate care needs of a patient experiencing an opioid overdose. The priority is to manage respiratory depression and potential cardiac arrest, making resuscitation equipment essential.

EXPLANATION

✔Correct answer:

"This medication may cause drowsiness, so I'll take it before bedtime." Desloratadine (Clarinex) is a second-generation antihistamine used to treat allergy symptoms, such as sneezing, runny nose, and itching. Unlike first-generation antihistamines (e.g., diphenhydramine), which are known to cause significant drowsiness, Desloratadine is non-sedating and is much less likely to cause drowsiness. The statement, "This medication may cause drowsiness, so I'll take it before bedtime," indicates that the patient may be confusing Desloratadine with a first-generation antihistamine that is more sedating. Nurse Laura should clarify that Desloratadine is designed to be taken during the day and generally does not cause drowsiness.

Desloratadine works by selectively inhibiting peripheral histamine H1 receptors, which are involved in the allergic response. Because it does not readily cross the blood-brain barrier, Desloratadine has minimal central nervous system effects, such as sedation or drowsiness, which is a common issue with older, first-generation antihistamines. This allows patients to use it without the sedative side effects that might interfere with daily activities, including driving or working.

Taking Desloratadine is like using a targeted bug spray that only affects the pests (allergy symptoms) without fogging up the whole house (causing drowsiness). It’s designed to treat the symptoms without making you feel sleepy.

Nurse Laura should explain to the patient that Desloratadine is a non-drowsy antihistamine and is typically taken once daily in the morning or at the same time each day. The patient should be informed that if they do experience drowsiness, it is unusual and they should report it to their healthcare provider.

• Clarify that Desloratadine is non-sedating and does not need to be taken at bedtime to avoid drowsiness.
• Encourage the patient to take the medication at the same time every day for consistent symptom relief.
• Instruct the patient to monitor for any unusual side effects and report them to their healthcare provider.
• Reassure the patient that they can engage in normal activities, such as driving, but to be cautious the first time they take the medication.

✘Incorrect answer options:

"I should take this medication at the same time every day, even if I'm not experiencing symptoms." This statement is correct. Desloratadine is most effective when taken regularly, even when symptoms are not present, as it helps maintain a stable level of medication in the body to prevent allergy symptoms from occurring.

"I'll avoid driving until I know how this medication affects me." This statement is also correct. While Desloratadine is non-drowsy, it’s prudent for patients to avoid driving or operating heavy machinery until they know how the medication affects them, especially when taking it for the first time.

"I can take this medication with or without food." This statement is correct as well. Desloratadine can be taken with or without food, as food does not significantly affect its absorption or effectiveness.

EXPLANATION

✔Correct answer:

“I’ll take the medication exactly as prescribed.” The correct approach to antiviral treatment for influenza involves taking the medication exactly as prescribed. Antiviral medications, such as oseltamivir (Tamiflu), are most effective when taken early in the course of the illness (usually within the first 48 hours of symptom onset). Even if the patient starts to feel better, it is important to complete the entire course of medication to ensure that the virus is fully suppressed and to reduce the risk of developing antiviral resistance.

Influenza is a viral infection caused by the influenza virus, which affects the respiratory tract. Antiviral medications like oseltamivir work by inhibiting the neuraminidase enzyme, which the virus needs to replicate and spread within the body. By taking the medication exactly as prescribed, the patient ensures that the viral load is reduced, symptoms are lessened, and the duration of illness is shortened. Stopping the medication early can lead to incomplete treatment, allowing the virus to rebound and potentially leading to complications or the development of resistance.

Taking antiviral medication as prescribed is like finishing a course of antibiotics for a bacterial infection. Even if you start feeling better, completing the course ensures that all the harmful agents are eliminated and reduces the risk of them coming back stronger.

Nurse Sarah should reinforce the importance of adhering to the prescribed treatment regimen and explain that completing the full course of antiviral medication is essential for effective treatment. She should also discuss potential side effects and the importance of not returning to regular activities too soon to avoid spreading the virus to others.

• Emphasize the importance of taking the full course of antiviral medication as prescribed.
• Educate the patient on possible side effects and how to manage them.
• Advise the patient to stay home and avoid close contact with others until they are no longer contagious, even while on medication.
• Remind the patient to monitor their symptoms and seek further medical attention if their condition worsens.

✘Incorrect answer options:

“I won’t be able to spread the virus to others while taking this medication.” This statement is incorrect because antiviral medications reduce the severity and duration of symptoms but do not completely prevent the spread of the virus to others. The patient should still follow precautions, such as staying home and avoiding contact with others, to prevent spreading the virus.

“I can go back to my regular activities since these medications have few side effects.” This statement is incorrect. Even if the medication has few side effects, the patient should not resume regular activities until they are no longer contagious and have fully recovered. Returning to normal activities too soon can spread the virus and may also prolong recovery.

“I’ll stop taking the medication as soon as I start feeling better.” This statement is incorrect because stopping antiviral medication prematurely can lead to incomplete treatment, potentially allowing the virus to rebound and increasing the risk of complications or resistance. It is essential to complete the full course of treatment.

EXPLANATION

✔Correct answer:

Tingling and numbness of the fingers. Tingling and numbness of the fingers, also known as peripheral neuropathy, is NOT typically associated with Rifabutin (Mycobutin). Peripheral neuropathy is more commonly associated with other tuberculosis medications, such as Isoniazid, which can cause this side effect due to pyridoxine (Vitamin B6) deficiency. Rifabutin does not typically cause this type of neurological side effect.

Rifabutin is a rifamycin antibiotic, similar to Rifampin, used to treat Mycobacterium avium complex (MAC) and tuberculosis. It works by inhibiting bacterial RNA synthesis, leading to the death of the bacteria. While Rifabutin is effective in treating these infections, it can have several side effects, including flu-like symptoms, arthralgia (joint pain), and blurred vision. These occur due to the drug's effects on various body systems but do not usually involve the peripheral nerves, which are responsible for sensations like tingling and numbness.

Think of Rifabutin as a specialized tool designed to fix specific issues (like infections), but it's not meant to tinker with the electrical wiring (nerves). Therefore, it doesn’t typically cause tingling or numbness, which would be like an electrical issue.

Nurse Jenna should monitor the patient for the side effects that are more commonly associated with Rifabutin, such as flu-like symptoms, arthralgia, and blurred vision. If the patient reports tingling or numbness in their fingers, Nurse Jenna should investigate other potential causes or consider if the patient is taking other medications, such as Isoniazid, which might be responsible.

• Monitor the patient for flu-like symptoms, including fever, chills, and malaise, which are common side effects of Rifabutin.
• Assess the patient for joint pain (arthralgia) and manage this symptom as needed.
• Regularly check the patient's vision and advise them to report any changes, as Rifabutin can cause blurred vision or uveitis.
• If the patient reports tingling or numbness, consider other potential causes or medications that might be contributing to this symptom.

✘Incorrect answer options:

Flu-like symptoms. Flu-like symptoms, such as fever, chills, and malaise, are common side effects of Rifabutin and can occur intermittently during treatment.

Arthralgia. Arthralgia, or joint pain, is another potential side effect of Rifabutin, which may require symptomatic treatment to manage discomfort.

Blurred vision. Blurred vision is a known side effect of Rifabutin and may be related to uveitis, an inflammation of the middle layer of the eye. Patients should be advised to report any visual changes promptly.

EXPLANATION

✔Correct answer:

Swelling of the lips or tongue. Omalizumab (Xolair) is a monoclonal antibody used to treat moderate to severe persistent asthma that is not adequately controlled with inhaled corticosteroids. One of the most serious adverse reactions associated with Omalizumab is anaphylaxis, a life-threatening allergic reaction. Symptoms of anaphylaxis can include swelling of the lips, tongue, or throat, difficulty breathing, hives, and a drop in blood pressure. Swelling of the lips or tongue in a patient who has received Omalizumab is a red flag for a potential anaphylactic reaction, and Nurse Jessica should be prepared to act immediately by administering epinephrine and providing emergency care.

Omalizumab works by binding to immunoglobulin E (IgE), a key antibody involved in allergic responses, thereby preventing IgE from interacting with its receptors on mast cells and basophils. While this mechanism can effectively reduce allergic inflammation in asthma, it can also trigger an anaphylactic reaction in rare cases. Anaphylaxis occurs when large amounts of histamine and other mediators are released from mast cells, leading to widespread vasodilation, increased vascular permeability, and smooth muscle contraction. This can result in airway obstruction, severe hypotension, and even death if not treated promptly.

Imagine anaphylaxis as a fire breaking out in a building. The swelling of the lips or tongue is like seeing smoke—an early warning sign that something dangerous is happening, and immediate action (emergency care) is needed to prevent a disaster.

Nurse Jessica should monitor the patient closely for any signs of anaphylaxis, especially within the first two hours after administering Omalizumab, as this is when the risk is highest. If anaphylaxis is suspected, she should immediately administer epinephrine, provide oxygen, and initiate other emergency interventions. The patient should also be observed in a healthcare setting for an extended period after receiving Omalizumab due to the risk of delayed anaphylactic reactions.

• Monitor the patient closely for signs of anaphylaxis, including swelling of the lips, tongue, or throat, difficulty breathing, and hives.
• Be prepared to administer epinephrine and provide other emergency treatments if anaphylaxis occurs.
• Ensure the patient remains under observation for at least 2 hours after receiving Omalizumab to monitor for delayed reactions.
• Educate the patient's caregivers about the signs of anaphylaxis and the importance of seeking immediate medical attention if these symptoms occur.

✘Incorrect answer options:

Joint pain. Joint pain can occur as a side effect of Omalizumab, but it is not indicative of a life-threatening reaction. It is generally considered a less serious adverse effect and would not require emergency intervention.

Nausea and vomiting. Nausea and vomiting can be side effects of many medications, including Omalizumab, but they do not signal a life-threatening reaction like anaphylaxis. These symptoms should be managed supportively, but they do not necessitate the same level of urgency.

Headache and dizziness. Headache and dizziness are common side effects of Omalizumab, but they are not indicative of anaphylaxis or another serious allergic reaction. These symptoms typically resolve on their own and do not require emergency treatment.

EXPLANATION

✔Correct answer:

Report any yellowing of your skin. Isoniazid (INH) is a first-line medication used in the treatment and prevention of tuberculosis (TB). One of the significant risks associated with long-term use of INH is hepatotoxicity, which can manifest as jaundice (yellowing of the skin or eyes). This symptom indicates liver damage, a serious side effect that requires immediate medical attention. Therefore, Nurse Daniel should instruct the patient to report any signs of jaundice or other symptoms of liver dysfunction, such as dark urine, fatigue, or abdominal pain.

Isoniazid is metabolized in the liver, where it can cause hepatocellular injury. This injury leads to the release of liver enzymes (AST and ALT) into the bloodstream and can progress to hepatotoxicity if left unchecked. The yellowing of the skin and sclera, known as jaundice, occurs due to the accumulation of bilirubin in the blood, a result of impaired liver function. Early detection and reporting of these symptoms are crucial to prevent severe liver damage.

Think of your liver as a filter that keeps everything running smoothly. If the filter gets clogged (hepatotoxicity from INH), waste builds up (bilirubin), leading to yellowing (jaundice). Spotting the problem early can help prevent serious damage.

Nurse Daniel should emphasize the importance of monitoring for any signs of liver dysfunction and reporting them immediately. He should also discuss lifestyle factors, such as avoiding alcohol, which can increase the risk of liver damage when taking INH. Additionally, the patient may need to take Vitamin B6 (pyridoxine) supplements to prevent INH-induced peripheral neuropathy.

• Instruct the patient to report any signs of jaundice, such as yellowing of the skin or eyes, dark urine, or persistent fatigue.
• Advise the patient to avoid alcohol consumption during therapy with INH, as it can exacerbate the risk of liver damage.
• Discuss the importance of taking Vitamin B6 supplements as prescribed to prevent peripheral neuropathy, a common side effect of INH.
• Encourage regular follow-up visits to monitor liver function and ensure the safe use of INH.

✘Incorrect answer options:

Increase your intake of tuna for extra nutrition. While nutrition is important, tuna is high in histamine, which can interact with INH and potentially lead to adverse effects like flushing, headache, and palpitations. Patients on INH should avoid foods high in tyramine and histamine, such as certain fish, aged cheeses, and processed meats.

It's okay to drink alcohol in moderation. This statement is incorrect. Alcohol consumption should be avoided during INH therapy because it increases the risk of hepatotoxicity. Alcohol can potentiate the liver-damaging effects of INH, leading to serious complications.

Discontinue taking vitamin supplements like Vitamin B6. This statement is incorrect. On the contrary, Vitamin B6 (pyridoxine) supplementation is often necessary during INH therapy to prevent peripheral neuropathy, a common side effect of INH. Discontinuing Vitamin B6 supplements could increase the risk of developing nerve-related symptoms.

EXPLANATION

✔Correct answer:

Ethionamide (Trecator). Ethionamide (Trecator) is not an antiviral medication and is not used to treat influenza. Instead, Ethionamide is an antibiotic used as part of the treatment regimen for tuberculosis, particularly in cases of multidrug-resistant TB (MDR-TB). It works by inhibiting mycolic acid synthesis, which is essential for the mycobacterial cell wall. Since it is specifically an anti-tubercular agent, it has no effect on the influenza virus.

Influenza is caused by the influenza virus, and antiviral medications are used to reduce the severity and duration of flu symptoms. These antivirals work by inhibiting various stages of the viral life cycle, such as preventing the virus from entering host cells or stopping viral replication. Ethionamide, on the other hand, targets the bacterial cell wall of Mycobacterium tuberculosis and is not effective against viral pathogens like the influenza virus.

Think of treating a viral infection like stopping a computer virus. Antiviral drugs are like antivirus software, designed specifically to deal with computer viruses. Ethionamide, in this analogy, would be like using a tool meant to repair a car's engine (treat TB) on a computer—it’s not designed for that purpose and wouldn’t work.

Nurse Megan should clarify to the patient that Ethionamide is not an antiviral medication and discuss the appropriate antiviral options available for treating influenza. She should ensure that the patient understands which medications are used for viral infections like influenza and which are used for bacterial infections, particularly tuberculosis.

• Ensure the patient understands that Ethionamide is used to treat tuberculosis, not viral infections like influenza.
• Discuss the appropriate antiviral medications for influenza, such as Oseltamivir and Zanamivir.
• Educate the patient on the importance of taking antiviral medications early in the course of influenza to reduce symptom severity and duration.

✘Incorrect answer options:

Amantadine (Symmetrel). Amantadine is an antiviral medication that was used to treat and prevent influenza A. However, due to widespread resistance, it is no longer commonly used for this purpose.

Zanamivir (Relenza). Zanamivir is a neuraminidase inhibitor used to treat and prevent influenza A and B. It works by blocking the release of new virus particles from infected cells.

Oseltamivir (Tamiflu). Oseltamivir is another neuraminidase inhibitor that is used to treat and prevent influenza A and B. Like Zanamivir, it works by inhibiting the enzyme neuraminidase, which is essential for viral replication and spread.

EXPLANATION

✔Correct answer:

It will cause orange discoloration of sweat, urine, and feces. One of the most well-known side effects of Rifampin (Rifadin) is the orange-red discoloration of body fluids, including sweat, urine, feces, saliva, and tears. This harmless side effect can be alarming to patients if they are not forewarned, so it is crucial for Nurse Emily to inform the patient about this to prevent unnecessary concern. The discoloration is due to the reddish-orange pigment in Rifampin, which is excreted in various body fluids.

Rifampin is an antibiotic commonly used to treat tuberculosis and other bacterial infections. It works by inhibiting the bacterial DNA-dependent RNA polymerase, thereby preventing the bacteria from synthesizing RNA and proteins, leading to bacterial death. The drug's pigment is highly lipophilic, meaning it easily dissolves in body fluids and tissues, leading to the characteristic orange discoloration of bodily secretions. This discoloration is benign and does not indicate harm or toxicity.

Imagine Rifampin as a bright red marker that leaves a trace wherever it goes. Just as the marker would leave red marks on a page, Rifampin leaves an orange-red tint on your body's fluids. It’s normal and nothing to worry about.

Nurse Emily should emphasize that the orange discoloration is expected and harmless. She should also advise the patient to avoid wearing contact lenses, as the medication can permanently stain them. The patient should also be informed that the discoloration may affect clothing and bedding, so they might want to take precautions to prevent staining.

• Inform the patient that Rifampin will likely cause orange discoloration of body fluids and that this is normal and harmless.
• Advise the patient to avoid wearing contact lenses during treatment, as they can become permanently discolored.
• Recommend that the patient take precautions to prevent staining of clothing and bedding.
• Encourage the patient to report any other unusual symptoms, especially signs of liver dysfunction, such as jaundice or severe fatigue, as Rifampin can cause hepatotoxicity.

✘Incorrect answer options:

It should be taken with food and antacids. This statement is incorrect. Rifampin is best absorbed when taken on an empty stomach, 1 hour before or 2 hours after a meal. Taking it with food, particularly high-fat foods or antacids, can reduce its absorption and effectiveness.

It should be discontinued after three months. This statement is incorrect. The duration of Rifampin therapy depends on the specific infection being treated. For tuberculosis, it is typically prescribed as part of a longer combination therapy, often for 6-9 months. Discontinuing the medication prematurely can lead to treatment failure and antibiotic resistance.

Take an extra dose if you miss one. This statement is incorrect and potentially dangerous. If a dose is missed, the patient should take it as soon as they remember, but if it is almost time for the next dose, they should skip the missed dose and continue with their regular schedule. Taking an extra dose can increase the risk of side effects, including hepatotoxicity.

EXPLANATION

✔Correct answer:

Cranial nerve VIII. Streptomycin, an aminoglycoside antibiotic, is known to have ototoxic effects, which can cause damage to cranial nerve VIII, also known as the vestibulocochlear nerve. This nerve is responsible for hearing and balance. Ototoxicity from streptomycin can lead to hearing loss, tinnitus (ringing in the ears), and balance disturbances, such as vertigo. These side effects occur because the drug can cause damage to the hair cells in the inner ear, which are critical for hearing and equilibrium.

The vestibulocochlear nerve (cranial nerve VIII) has two main components: the cochlear nerve, which is involved in hearing, and the vestibular nerve, which is involved in balance. Streptomycin can accumulate in the inner ear, where it causes damage to the sensory hair cells in the cochlea (affecting hearing) and in the vestibular system (affecting balance). The damage to these cells can be irreversible, leading to permanent hearing loss or chronic balance issues. This risk is particularly high with prolonged use or in patients with pre-existing renal impairment, as the drug is excreted through the kidneys.

Imagine cranial nerve VIII as a telephone line that connects your ear to your brain. Streptomycin can damage this line, causing static (tinnitus) or cutting off the connection entirely (hearing loss), and can also make you feel dizzy (balance issues).

Nurse Paul should educate the patient about the signs and symptoms of ototoxicity, such as hearing loss, ringing in the ears, or dizziness, and instruct them to report any of these symptoms immediately. Regular monitoring of hearing and balance function should be conducted during treatment, especially if the patient is receiving long-term therapy or has other risk factors for ototoxicity.

• Inform the patient about the risk of ototoxicity and the importance of reporting early signs such as hearing changes, tinnitus, or balance problems.
• Monitor the patient's hearing and balance function regularly during treatment with streptomycin.
• Advise the patient to avoid other ototoxic drugs or excessive noise exposure while taking streptomycin to minimize the risk of hearing damage.
• Ensure the patient has regular follow-up appointments to assess for any early signs of ototoxicity.

✘Incorrect answer options:

Cranial nerve VII. Cranial nerve VII is the facial nerve, which controls the muscles of facial expression. Damage to this nerve can cause facial weakness or paralysis, but it is not typically affected by streptomycin.

Cranial nerve IX. Cranial nerve IX is the glossopharyngeal nerve, which is involved in taste sensation and swallowing. Streptomycin does not commonly cause damage to this nerve.

Cranial nerve X. Cranial nerve X is the vagus nerve, which controls autonomic functions such as heart rate and digestion. Streptomycin is not associated with damage to the vagus nerve.