# A client has been on metoclopramide 10 mg QID for 14 weeks for diabetic gastroparesis and reports new repetitive lip-smacking and tongue protrusions. Which is the nurse's priority action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391808&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client has been on metoclopramide 10 mg QID for 14 weeks for diabetic gastroparesis and reports new repetitive lip-smacking and tongue protrusions. Which is the nurse's priority action?

## Option

1. Hold metoclopramide and notify the provider — tardive dyskinesia is a serious adverse effect carrying a boxed warning; risk increases beyond 12 weeks **✔ Correct answer**
2. Continue therapy and add benztropine
3. Increase the dose for better symptom control
4. Reassure the client and observe for 1 month

**Correct answer: 1**

## Explanation

Correct (2): Metoclopramide carries a boxed warning for tardive dyskinesia — irreversible involuntary movements; risk rises with duration >12 weeks, elderly, and women. Stop the drug and notify the provider. (1) Benztropine treats acute dystonia, not TD; continuing increases harm. (3) Higher dose worsens. (4) Delay risks permanent TD.

## In-depth explanation

Memory Tip Metoclopramide = "Met-OFF after 12 weeks" — boxed warning. Tardive dyskinesia ≠ Acute dystonia (benztropine works). Pediatric/elderly need lowest dose, shortest duration.

## Clinical scenario

Scenario 62-year-old female on metoclopramide 10 mg PO QID × 14 weeks for diabetic gastroparesis. New lip-smacking, tongue protrusion, involuntary facial movements.

## Key concepts

- **Metoclopramide** — D2 antagonist prokinetic for gastroparesis, GERD, and antiemetic.
- **Tardive dyskinesia** — Late-onset involuntary repetitive movements; potentially irreversible.
- **Duration-limited therapy** — Metoclopramide use should not exceed 12 weeks unless benefit clearly outweighs risk.

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