A 75-year-old patient with pneumonia and a history of hypertension and diabetes is scheduled for a CT scan with contrast. What medications should the nurse recognize as nephrotoxic and which action should the nurse prioritize to minimize the risk of acute kidney injury.

Choice A rationale Novolog and Lantus represent rapid acting and long acting insulins used to manage blood glucose levels in diabetic patients. While insulin itself is not typically nephrotoxic, the primary concern for a patient with diabetes undergoing a contrast study is the potential for acute kidney injury which can be exacerbated by preexisting renal impairment. Fasting for 12 hours is not a standard priority for minimizing nephrotoxicity risks and may actually lead to hypoglycemia in patients with diabetes. Choice B rationale Flagyl is an antimicrobial often used for anaerobic infections and is not a primary nephrotoxin in this context. Metformin is not directly nephrotoxic but must be held because if contrast induced nephropathy occurs, the drug can accumulate and cause life threatening lactic acidosis. Obtaining a baseline serum creatinine level after the procedure is incorrect as the assessment of renal function must occur before the administration of contrast to identify patients at high risk for injury. Choice C rationale Vancomycin is a glycopeptide antibiotic known for potential nephrotoxicity, and intravenous contrast dye is a well documented cause of acute kidney injury. However, the action to administer a dose of metformin before the procedure is dangerous and contraindicated. Metformin should be discontinued at the time of or prior to the procedure and withheld for 48 hours afterward until renal function is confirmed to be stable to prevent the development of metabolic lactic acidosis. Choice D rationale Gentamicin is an aminoglycoside antibiotic with significant nephrotoxic potential, and Metformin carries risks if renal function declines. Prioritizing intravenous fluid administration is the most effective nursing action to prevent contrast induced nephropathy. Adequate hydration promotes renal blood flow and dilutes the contrast media within the renal tubules, facilitating its excretion. Normal serum creatinine levels typically range from 0.7 to 1.3 mg/dL for men and 0.6 to 1.1 mg/dL for women.