A client with type II diabetes mellitus is prescribed metformin. The patient is preparing for a computerized tomography (CT) scan with contrast. Which interventions by the nurse are appropriate for this patient? Select all that apply

A. Educate the client to increase fluid intake after the CT scan: Hydration helps flush the contrast medium from the kidneys, lowering the risk of contrast-induced nephropathy. Increased fluids reduce the chance of metformin accumulation and subsequent lactic acidosis. B. Monitor the client's GFR, creatinine and blood urea nitrogen (BUN) levels: Renal function monitoring is critical because impaired kidney clearance can lead to metformin accumulation. Checking these labs ensures the kidneys can safely process both contrast and the medication. C. Ensure the patient has orders to hold metformin for 48 hours after the CT scan: Holding metformin prevents the risk of lactic acidosis if renal function declines due to contrast. The drug should be restarted only after renal function is reassessed and confirmed as stable. D. Ensure the patient has withheld metformin for at least 6 hours before the scan: Holding metformin 6 hours before is not sufficient or evidence-based. The main concern is after contrast exposure, not before, so this intervention does not adequately address safety. E. Advise the client to remain NPO for 24 hours before the CT scan: Clients may be NPO for a few hours before the scan depending on the contrast type, but 24 hours of fasting is not required. Prolonged NPO status may instead increase the risk of hypoglycemia. F. Educate the client to resume metformin immediately after the CT scan is completed: Restarting metformin immediately could lead to lactic acidosis if renal function is impaired. Safe resumption should occur only after renal function has been re-evaluated at least 48 hours post-procedure.