Which of the following is important for the nurse to assess and monitor in a patient prescribed metformin (Glucophage)? (Select All that Apply.)

A. Presence of renal or hepatic disease: Metformin, commonly prescribed for type 2 diabetes, is primarily excreted by the kidneys. Patients with renal impairment are at increased risk of metformin accumulation, potentially leading to lactic acidosis. Assessing for the presence of renal or hepatic disease helps determine the appropriate dosage of metformin and reduces the risk of adverse effects.
B. Fluid retention: Metformin does not typically cause fluid retention; however, monitoring for signs of fluid retention is important, especially in patients with underlying conditions such as heart failure, as fluid retention can exacerbate their condition.
C. Need for diagnostic tests involving the use of contrast dyes: Metformin can increase the risk of lactic acidosis, particularly in patients undergoing procedures involving contrast dyes. Temporarily discontinuing metformin before such procedures reduces the risk of adverse effects.
D. Weight gain: Metformin is associated with weight neutrality or even modest weight loss. Monitoring weight changes can help assess treatment response and overall health.
E. Presence of heart failure: Metformin is contraindicated in patients with severe heart failure due to the potential risk of lactic acidosis. Assessing for the presence of heart failure helps ensure safe prescribing practices and avoids potential complications associated with metformin use in this population.