1Give the next dose early because the movements indicate returning gastroparesis symptoms.
2Apply oxygen and encourage ambulation because the movements represent medication-related sedation.
3Hold metoclopramide and notify the prescriber promptly about suspected tardive dyskinesia.✓ Correct answer
4Administer an antidiarrheal and continue therapy until the planned 6-month review.
Explanation
Lip smacking and tongue protrusion after prolonged metoclopramide exposure are characteristic of tardive dyskinesia, a serious movement disorder that can be irreversible. The drug should be discontinued when signs develop and the prescriber should be notified promptly. Treatment beyond 12 weeks increases risk. Additional doses, delayed review, oxygen, ambulation, or an antidiarrheal do not address this adverse effect.
Clinical reasoning Metoclopramide blocks dopamine receptors. Cumulative exposure increases the risk of persistent involuntary facial, tongue, trunk, or limb movements.
Decision rule New involuntary movements during metoclopramide therapy require drug interruption, prompt evaluation, and documentation of the suspected adverse reaction.
Scenario A 62-year-old client has taken metoclopramide 10 mg four times daily for 14 weeks and now has lip smacking and repetitive tongue protrusion.
Tardive dyskinesia — A potentially irreversible movement disorder marked by repetitive involuntary movements after dopamine-receptor blockade.
Metoclopramide — A dopamine antagonist used for selected gastrointestinal disorders that carries a boxed warning for tardive dyskinesia.
Duration-limited therapy — Metoclopramide use should not exceed 12 weeks unless benefit clearly outweighs risk.