The nurse receives prescriptions for a client who is Immediately post coronary angiogram with contrast for angina. Which prescription should the nurse question?

Metformin should be questioned in a client who has just undergone a coronary angiogram with iodinated contrast dye. Contrast media can cause acute kidney injury, and if renal function is compromised, metformin cannot be adequately cleared from the body. The resulting accumulation dramatically increases the risk of lactic acidosis, a potentially life-threatening complication. Current guidelines recommend holding metformin at the time of contrast administration and for 48 hours afterward, restarting only after renal function has been confirmed to be stable. Morphine given intravenously as needed for pain is appropriate post-procedure analgesia. Metoprolol is a beta-blocker commonly used in clients with coronary artery disease and angina; it is not contraindicated in this setting. Clopidogrel is an antiplatelet agent indicated after coronary procedures, including angioplasty or stenting, to prevent thrombosis, making it an expected and appropriate prescription. Only metformin poses a direct pharmacologic risk in the immediate post-contrast period and is the prescription the nurse should question and clarify with the provider before administering.