The client is ordered to receive 40 mg of atorvastatin PO daily. In the medication cabinet, you find 10 mg tablets. How many tablets will you administer to the client? (Enter a numerical value only)

A) Touch the tip of the bottle to the lacrimal duct: Touching the tip of the bottle to the lacrimal duct is not a recommended practice when administering eye drops. This could introduce bacteria into the eye or nose, leading to potential infection. The goal is to administer the drops without contamination, and the tip of the bottle should never touch the eye or any part of the face.

B) Apply pressure to inner canthus for 2 minutes: Applying pressure to the inner canthus (the corner of the eye near the nose) for about 2 minutes after administering ophthalmic drops is a key step when using systemically acting eye medications like propranolol. This helps to prevent the systemic absorption of the medication through the nasolacrimal duct, reducing the risk of systemic side effects such as bradycardia or hypotension. This step ensures that the medication stays localized in the eye.

C) Have client lie down or tilt the back of their head: While lying down or tilting the head back may help the client instil the drops more comfortably, it is not a required step for the proper absorption or effectiveness of eye drops. The key to effective administration lies in positioning the drop in the correct part of the eye and minimizing systemic absorption, which is achieved by applying pressure to the inner canthus, not necessarily by tilting the head.

D) Have client pull down their lower eyelid: Pulling down the lower eyelid is a standard step in administering eye drops, as it creates a small pocket to hold the drop. However, it does not specifically address the concern for reducing systemic absorption of a medication like propranolol. The primary step for preventing systemic effects is applying pressure to the inner canthus after administration, making this less relevant for this specific question.

A) Hypersensitivity reaction: A hypersensitivity reaction typically involves an immune response where the body reacts to a substance as if it were harmful, leading to symptoms like rashes, swelling, or difficulty breathing. However, low hemoglobin and low white blood cell counts are not typical signs of a hypersensitivity reaction. This would involve more common allergic symptoms like itching or swelling, rather than hematologic changes.

B) Paradoxical reaction: A paradoxical reaction refers to when a medication causes an effect opposite to the expected result. For example, a sedative causing agitation instead of sleepiness. While a paradoxical reaction can involve unexpected effects, the hematologic changes (low hemoglobin and white blood cell counts) in this scenario do not align with this type of response.

C) Idiosyncratic reaction: An idiosyncratic reaction is an unusual or unexpected response to

a medication that is not related to the drug's pharmacologic properties or the dose given. It may be related to genetic factors or other individual differences in how a person metabolizes or responds to the drug. The low hemoglobin and low white blood cell counts in this case are unusual effects of diphenhydramine and suggest an idiosyncratic response, where the client’s body is reacting in an unexpected way to the medication.

D) Anti-cholinergic reaction: Anti-cholinergic reactions are typically related to symptoms caused by the blocking of acetylcholine, such as dry mouth, blurred vision, urinary retention, or constipation. While diphenhydramine has anti-cholinergic properties, the symptoms described (low hemoglobin and white blood cell counts) are not typical of an anti-cholinergic reaction.