A client with chemotherapy induced nausea receives a prescription for metoclopramide. Which adverse effect is most important for the nurse to report?

Rationale: A. Nausea: Persistent nausea may indicate reduced effectiveness of metoclopramide, but it is not the most concerning adverse effect. The drug’s primary risk lies in its impact on the central nervous system, which can cause more serious complications. B. Involuntary movements: Metoclopramide can cause extrapyramidal symptoms such as dystonia, tardive dyskinesia, and parkinsonism due to dopamine receptor blockade. These involuntary movements may be irreversible and require immediate reporting to prevent worsening of symptoms. C. Diarrhea: Diarrhea is a common side effect because of the medication’s prokinetic action on the gastrointestinal tract. While uncomfortable, it is generally not life-threatening compared to the neurological risks associated with the drug. D. Unusual irritability: Irritability may occur with central nervous system effects but is less severe than extrapyramidal symptoms. Although it should be monitored, it does not demand the same urgency as reporting involuntary movements.