Final answer:
The nurse should question the prescription of metoclopramide IV if the client shows any signs of extrapyramidal symptoms. Additionally, monitoring for hypoglycemia and assessing renal function are crucial before administering this medication.
Step-by-step explanation:
Clinical Evaluation for Metoclopramide Administration
Before administering metoclopramide IV to a client with diabetic gastroparesis, the nurse must assess for any clinical findings that may contraindicate its use. One such finding that could cause the nurse to question the prescription is the presence of extrapyramidal symptoms (EPS), which are serious movement disorders that can be induced by metoclopramide. Symptoms may include involuntary muscle movements, facial grimacing, rigidity, shuffling walk, or tremors. Due to metoclopramide's dopamine antagonist properties, it may worsen conditions like Parkinson's disease, where dopamine levels are already compromised. In such cases, the nurse should immediately report these findings to the prescribing physician before proceeding with the administration of the medication.
The nurse should also monitor for signs of hypoglycemia, especially because medications like sulfonylureas, which are used to stimulate insulin secretion in diabetic patients, can cause hypoglycemia. Symptoms such as hunger, sweating, shakiness, and weakness could be indicative of this condition. Additionally, the nurse should consider renal function status, as renal dysfunction can also lead to hypoglycemia due to reduced reabsorption of filtered glucose.