A nurse is preparing to administer daily medications to a client who is undergoing a procedure at 1000 that requires IV contrast dye. Which of the following routine medications to give at 0800 should the nurse withhold?

Medication management before diagnostic procedures requiring IV contrast is an important nursing responsibility to prevent adverse drug–contrast interactions. Metformin is commonly used in clients with type 2 diabetes mellitus and is primarily excreted by the kidneys. Iodinated contrast media used in imaging studies can temporarily impair renal function, increasing the risk of drug accumulation. This interaction may lead to a serious complication known as lactic acidosis, which requires careful pre-procedure medication review. Rationale: A. Metformin should be withheld before and after procedures involving IV contrast dye because of the risk of contrast-induced nephropathy leading to reduced drug clearance. If renal function declines, metformin can accumulate in the body and increase the risk of lactic acidosis, a rare but potentially life-threatening condition. The medication is typically held before the procedure and resumed only after renal function is confirmed to be normal. B. Valproic acid does not need to be withheld prior to IV contrast administration because it is not primarily excreted through contrast-sensitive renal pathways and does not interact significantly with iodinated contrast media. It is an anticonvulsant used to manage seizure disorders and mood conditions. Routine administration can continue unless otherwise contraindicated for specific patient conditions. C. Fluticasone is an inhaled corticosteroid used for respiratory conditions such as asthma and does not interact with IV contrast dye. It has minimal systemic absorption when inhaled and does not affect renal function or contrast metabolism. Therefore, it is safe to administer as scheduled. D. Metoprolol is a beta-blocker used for hypertension and cardiac conditions and does not require withholding prior to contrast studies. It does not interact with iodinated contrast agents or increase risk of renal complications. Continuation helps maintain cardiovascular stability during diagnostic procedures.