# Review the metformin and renal-function timeline, then answer the questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513814&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

Review the metformin and renal-function timeline, then answer the questions.

| Time | Data |
| --- | --- |
| Day 1 at 0800 | eGFR 48 mL/min/1.73 m2; morning metformin held before iodinated contrast |
| Day 2 at 1000 | 24 hours after contrast; eGFR 45 mL/min/1.73 m2; metformin remains held |
| Day 3 at 1000 | 48 hours after contrast; eGFR 47 mL/min/1.73 m2; oral intake and hemodynamics stable |

Q1. Which interpretation is best at Day 3 at 1000?

The renal trend is unstable and metformin must never be used again
The 24-hour value alone was sufficient to restart metformin
The 48-hour renal function is stable enough to verify the prescribed restart plan
The next metformin dose should be doubled to replace missed doses

Q2. Which new finding would require continued holding and prompt follow-up?

eGFR decreases substantially from baseline at 48 hours
The client asks why metformin was held
The client eats the full breakfast
The blood pressure remains at the preprocedure baseline

## Explanation

For a client with eGFR 30 to 60 who receives iodinated contrast, metformin is held at or before the procedure and renal function is reassessed 48 hours later. It may be restarted if renal function is stable.

## In-depth explanation

Quick answer
The trend supports verifying a restart order after the 48-hour stable renal reassessment.

Why this is correct
The client's eGFR was within the labeled 30-to-60 range, so holding metformin for contrast was appropriate. At 48 hours, the value is close to baseline and stable; the nurse should confirm the restart order rather than restart it independently.

Easy analogy or mental picture
Think of the 48-hour renal check as a bridge inspection after a heavy load. Crossing resumes only after the structure is shown to be stable and the route is reopened.

Memory hook
Contrast plus eGFR 30 to 60: hold, recheck at 48 hours, restart if stable.

NCLEX decision rule
Use the whole timeline: indication for the hold, elapsed time, renal trend, and the current order. A single reassuring value before 48 hours does not complete the labeled sequence.

Why the other choices are wrong
Restarting at 24 hours is premature. Continuing the hold despite stable renal function may be unnecessary, while doubling the next dose is never a way to replace held doses.References
1DailyMed: Metformin HydrochlorideIodinated contrast hold and 48-hour renal reassessment

## Clinical scenario

Trend review
Check the preprocedure eGFR, contrast route and time, metformin hold, 48-hour renal result, and active restart order.

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_For study reference only. Always follow current clinical guidelines and your institution’s protocols._