An older adult client is scheduled for a computerized tomography scan with contrast. The nurse should anticipate pre-procedure administration of which medications to prevent renal damage? (Select All that Apply.)

Rationale: A. Sodium bicarbonate in a liter of 0.9% normal saline is often administered before contrast procedures to alkalinize the urine. Alkalinization helps reduce oxidative damage caused by contrast media on the renal tubular cells. This intervention is particularly important in patients with pre-existing renal impairment, such as chronic kidney disease, because they are at higher risk of developing contrast-induced nephropathy (CIN). Sodium bicarbonate is typically given via intravenous infusion starting a few hours before the procedure and sometimes continued after, depending on the protocol. B. Intravenous infusion of 0.9% normal saline before and after contrast administration is essential to maintain renal perfusion and hydration. Hydration helps flush the contrast dye through the kidneys, reducing the concentration of contrast in the renal tubules and lowering the risk of nephrotoxicity. It is considered the most effective and standard preventive measure for contrast-induced kidney injury, particularly in older adults or those with compromised renal function. C. Vitamin B12 is not used for the prevention of contrast-induced nephropathy. While essential for hematologic and neurologic function, it has no role in protecting the kidneys from contrast media. Administering vitamin B12 would not prevent renal damage in this context. D. Acetylcysteine is an antioxidant that may help reduce the oxidative stress caused by contrast agents on kidney cells. It can be administered orally or intravenously prior to contrast exposure, especially in high-risk patients. Although evidence on its efficacy is mixed, many protocols include acetylcysteine as a prophylactic measure to further reduce the likelihood of contrast-induced acute kidney injury. E. Vitamin D does not have a role in preventing renal damage from contrast media. Its function is primarily related to calcium and phosphate metabolism and bone health, not acute nephroprotection.