A nurse is reinforcing teaching with a client who is scheduled for a percutaneous kidney biopsy. Which of the following client statements indicates a need for further teaching?

A. "Take naproxen for discomfort.": Nonsteroidal anti-inflammatory drugs like naproxen inhibit platelet aggregation and can increase the risk of postoperative hemorrhage after a vascular procedure like a TURP. The nurse should advise the client to avoid medications that can exacerbate bleeding from the prostatic bed. Acetaminophen is generally preferred for mild discomfort in the postoperative period.

B. "Sexual activity is permitted after 2 weeks.": The surgical site in the prostatic urethra requires significant time to heal and re-epithelialize without the stress of sexual activity. Most surgeons recommend abstaining from sexual intercourse for at least 6 to 8 weeks to prevent secondary bleeding or trauma. Providing a 2-week timeframe is premature and increases the risk of complications.

C. "Increase fluid intake if urine becomes blood tinged.": Small amounts of blood or "cherry-colored" urine are common after a TURP, but increasing fluid intake helps flush the bladder to prevent clot formation. Adequate hydration maintains a continuous flow of dilute urine, which prevents the obstructive complications of hematuria. This instruction empowers the client to manage mild postoperative bleeding safely.

D. "Urinary dribbling will resolve within 5 days.": Urinary incontinence or dribbling after a TURP is common due to the removal of prostatic tissue and temporary sphincter weakness. This symptom can persist for several weeks or even months as the surrounding muscles regain their tone. Telling a client it will resolve in 5 days provides an unrealistic expectation for the recovery process.

A. Simvastatin: This HMG-CoA reductase inhibitor is used for lipid management and does not interact with iodinated contrast media to cause renal injury. There is no pharmacological contraindication for continuing statin therapy before a radiological study. Withholding this medication is unnecessary and does not provide protective benefits for the kidneys.

B. Pantoprazole: As a proton pump inhibitor, this medication manages gastric acid secretion and has no known synergistic toxicity with IV contrast dyes. It does not influence the hemodynamic or excretory functions of the renal system. Continuation of pantoprazole does not increase the risk of contrast-induced nephropathy or metabolic complications.

C. Valsartan: This angiotensin II receptor blocker is used for blood pressure control and is not typically withheld specifically for contrast studies unless acute kidney injury is already present. While it affects renal perfusion, it does not carry the same metabolic risk as other diabetic medications. Standard protocol allows for the administration of this drug pre-procedure.

D. Metformin: This medication must be withheld prior to and for 48 hours after contrast administration due to the risk of lactic acidosis. Contrast dye can cause transient renal impairment, leading to the accumulation of metformin in the bloodstream. Excessive metformin levels trigger a dangerous shift in systemic pH, resulting in metabolic acidosis.