A nurse in the emergency department is caring for a patient who was injured in a motor-vehicle crash. The patient reports dyspnea and severe pain.
The nurse notes that the patient’s chest moves inward during inspiration and bulges out during expiration. The nurse should identify this finding as which of the following?

Choice A rationale

Metoclopramide is a medication used for stomach and esophageal problems. It is commonly used to treat and prevent nausea and vomiting, to help with emptying of the stomach in people

with delayed stomach emptying, and to help with gastroesophageal reflux disease. The antiemetic action of metoclopramide is due to its antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system — this action prevents nausea and vomiting triggered by most stimuli.

Choice B rationale

While metoclopramide does have an effect on the muscles of the gastrointestinal tract, it does not work by relaxing them. Instead, it works by blocking dopamine receptors, which in turn stimulates motility in the upper gastrointestinal tract without stimulating gastric, biliary, or pancreatic secretions. This increased motility helps to speed up the rate at which the stomach empties into the intestines.

Choice C rationale

Metoclopramide does not work by decreasing gastric acid secretions. In fact, one unique property of this drug is that it does not increase gastric acid secretion. Its primary mechanism of action is to block dopamine receptors, thereby increasing muscle contractions in the upper digestive tract.

Choice D rationale

This is correct. Metoclopramide enhances gastric emptying. It is used to treat conditions like gastroesophageal reflux disease and diabetic gastroparesis, where delayed gastric emptying is a problem. By blocking dopamine receptors, metoclopramide increases muscle contractions in the upper digestive tract, speeding up the rate at which the stomach empties into the intestines.

Choice A rationale

Telling the patient that this is the medication their doctor wants them to take does not address the patient’s concern about the color of the pill.

Choice B rationale

While it’s true that the same medication can sometimes come in different colors, this response does not confirm that the orange pill is the correct medication for the patient.

Choice C rationale

Checking the medication order again is the best response. This will ensure that the patient is receiving the correct medication.

Choice D rationale

Explaining the purpose of the medication does not address the patient’s concern about the color of the pill.