Before a brain CT with contrast, which nursing finding should be reported to the physician?

• A. The client takes metformin daily.
• B. The client has not been NPO.
• C. The client reports an allergy to gadolinium.
• D. The client was not prescribed a bowel prep.

Answer: (A)

Metformin use before IV iodinated contrast is a safety concern. When a patient receives contrast, the risk of contrast-induced nephropathy can impair kidney function, which can lead to the accumulation of metformin. That buildup increases the risk of lactic acidosis, a serious complication. Because of this, the nurse must report that the client is taking metformin so the physician can decide to withhold the medication temporarily and reassess renal function before proceeding with the brain CT with contrast.

The other findings are less critical for this specific situation: not being NPO isn’t a problem for a brain CT with IV contrast; an allergy to gadolinium relates to MRI contrast rather than CT with iodinated contrast; and not having a bowel prep has no relevance to a brain CT.