When a patient receiving Metoclopramide, the nurse should assess for?

NORCET 5 Prelims - Sept 2023 (Shift-2)

Pharmacology

Easy

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

Disorientation.
Metoclopramide is a dopamine D₂-receptor antagonist that can cross the blood-brain barrier.
This action on the central nervous system (CNS) can lead to various side effects, including restlessness, drowsiness, agitation, and disorientation.
Monitoring for changes in mental status is a critical nursing responsibility for patient safety when administering this medication.
While extrapyramidal symptoms (EPS) are the most severe neurological side effect, disorientation is a significant and more common CNS effect to assess for.

Option A: This is the intended therapeutic effect of the drug, not an adverse effect. The nurse assesses for the clinical outcomes of increased peristalsis (e.g., reduced nausea, active bowel sounds) to evaluate the drug's efficacy.
Option B: Metoclopramide increases GI motility. Therefore, it is more likely to cause diarrhea or loose stools as a side effect, not constipation.
Option C: Metoclopramide's mechanism of action is as a prokinetic agent and dopamine antagonist; it does not significantly affect the secretion of gastric acid.

Visual 1: Diagram: A visual illustrating Metoclopramide's mechanism of action, showing its effects on the upper GI tract (increasing motility) and its ability to cross the blood-brain barrier to affect dopamine receptors in the brain, leading to both antiemetic effects and potential CNS side effects.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing assessment and monitoring for adverse effects of Metoclopramide to guide bedside assessment, documentation, and the next nursing action.
Patient Safety: Always prioritize monitoring for adverse effects, especially neurological changes, when administering drugs that affect the CNS. Disorientation can be an early sign of a more severe reaction.
Black Box Warning: Be aware that Metoclopramide has a black box warning for tardive dyskinesia, a serious and often irreversible movement disorder, with long-term or high-dose use. This underscores the importance of neurological assessment.
What if? If the patient developed involuntary muscle spasms of the face, neck, or back, the nurse should suspect acute dystonia, a type of extrapyramidal symptom. This is a medical emergency requiring immediate notification of the provider and potential administration of an anticholinergic agent like diphenhydramine.

How to Approach the Question

First, identify the drug mentioned: Metoclopramide. Recall its drug class (prokinetic, antiemetic) and primary mechanism (dopamine antagonist).
Analyze the question's core task: "the nurse should assess for?". This requires you to consider both therapeutic effects and potential adverse effects.
Evaluate each option: 'Increase peristalsis' is the desired effect. 'Constipation' and 'Increase gastric acid secretion' are incorrect actions. 'Disorientation' is a known adverse effect.
Prioritize the options. In nursing, monitoring for patient safety and adverse effects is a critical priority. CNS changes like disorientation can signal a serious problem.
Conclude that while assessing for therapeutic effect is important, assessing for a significant adverse effect like disorientation is a higher priority from a safety standpoint, making it the best answer.

Concept Tested & Keywords

Concept Tested: Nursing assessment and monitoring for adverse effects of Metoclopramide.
Stem keywords: Metoclopramide, nurse, assess for
Lead-in keywords: assess for
Negative lead-in flag: false

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