A nurse is caring for a patient with a chest tube connected to wall suction due to a right-sided pneumothorax. The patient reports a sensation of chest burning.
What should the nurse do next?

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

Confusion or disorientation can be a normal part of the dying process. As the body systems start to shut down, changes in mental status, including confusion, can occur.

Choice B rationale

Sundowning is a phenomenon that is typically associated with dementia, particularly Alzheimer’s disease, and is characterized by confusion and agitation that gets worse in the late afternoon and evening. It is not specifically associated with the dying process.

Choice C rationale

While anxiety can occur at any stage of illness, it is not the most appropriate response in this context. The family member is specifically asking about confusion, not anxiety.

Choice D rationale

Needing more rest could be a part of the dying process, but it does not directly address the family member’s concern about confusion.