During preadmission teaching for major surgery, a client reports taking dapagliflozin each morning. Which instruction should the nurse anticipate?

FDA labeling directs that dapagliflozin be withheld for at least 3 days before major surgery or prolonged fasting. This reduces perioperative ketoacidosis risk, which can occur without marked hyperglycemia.

Quick answer
Expect dapagliflozin to be withheld for at least 3 days before major surgery. The pause begins before the fasting day because the ketoacidosis risk can persist.

Why this is correct
SGLT2 inhibitors increase urinary glucose loss and can promote ketone production during surgical stress or reduced intake. Dapagliflozin therefore needs a preoperative interruption long enough to reduce the risk of perioperative ketoacidosis.

Easy analogy or mental picture
This is like shutting off a machine before maintenance while enough time remains for stored pressure to dissipate. The analogy explains the advance pause, but it does not determine glucose management or when the medication can safely restart.

Memory hook
Major surgery plus dapagliflozin means a 3-day preoperative hold to reduce ketoacidosis risk.

NCLEX decision rule
When an NCLEX item pairs major surgery or prolonged fasting with dapagliflozin, follow the labeled preoperative interruption. Do not continue it on the surgery morning, wait until fasting starts, or independently substitute another diabetes dose.

Why the other choices are wrong
Taking the drug on the surgery morning or waiting until fasting begins leaves insufficient interruption time. An extra metformin dose is not an equivalent substitute and should not be created by the nurse.