A nurse is caring for a client who has a prescription for metoclopramide. Which of the following outcomes should the nurse use to evaluate the effectiveness of this medication?

The nurse should first address the client’s oxygen saturation, followed by the client’s blood pressure.

Addressing the oxygen saturation is crucial because the client’s level has dropped significantly to 86%, indicating potential respiratory distress or hypoxia. Following that, the nurse should address the blood pressure, which has also dropped, indicating possible hemodynamic instability.

Let’s break down the case notes to understand why addressing the client’s oxygen saturation and blood pressure is critical:

Oxygen Saturation

• Initial Vital Signs (1200): The client’s oxygen saturation was 100% on 2 L oxygen via nasal cannula.
• Current Vital Signs (1220): The oxygen saturation has dropped to 86% on the same oxygen support.

This significant drop in oxygen saturation indicates that the client is not receiving adequate oxygen, which can lead to hypoxia. Hypoxia can cause severe complications, including organ damage. Therefore, improving oxygenation is the top priority.

Blood Pressure

• Initial Vital Signs (1200): The client’s blood pressure was 110/75 mm Hg.
• Current Vital Signs (1220): The blood pressure has decreased to 90/60 mm Hg.

The drop in blood pressure suggests that the client is experiencing hemodynamic instability, which could be due to several factors, including dehydration, blood loss, or a reaction to anesthesia. Low blood pressure can lead to inadequate perfusion of vital organs, which is why it needs to be addressed promptly after stabilizing the oxygen saturation.

Other Symptoms

• Muscle Rigidity: The client is experiencing painful muscle rigidity, which could be a sign of a serious condition like malignant hyperthermia, especially given the elevated temperature.
• Temperature: The client’s temperature has spiked to 40.2°C (104.4°F), indicating a possible infection or reaction.
• Heart Rate: The heart rate has increased to 125/min, which could be a compensatory response to low blood pressure and hypoxia.
• Nausea and Vomiting: The client has vomited twice, which could contribute to dehydration and electrolyte imbalance.

Conclusion

By addressing the oxygen saturation first, the nurse ensures that the client is receiving adequate oxygen, which is essential for all bodily functions. Following that, stabilizing the blood pressure is crucial to ensure proper perfusion and prevent further complications.

Choice A rationale
Limiting caffeine is not the first action the nurse should take. While caffeine can exacerbate symptoms of BPH, it is not the priority action when starting doxazosin IR3.
Choice B rationale
Reporting headaches is important, but it is not the first action the nurse should take. Headaches can be a side effect of doxazosin, but monitoring the patient’s initial response to the medication is more critical.
Choice C rationale
Measuring the client’s intake and output is important for monitoring urinary symptoms, but it is not the first action the nurse should take when starting doxazosin IR3.
Choice D rationale
Administering the medication at bedtime is the correct first action. Doxazosin can cause dizziness and hypotension, especially after the first dose, so taking it at bedtime can help minimize these effects.