# A client takes empagliflozin for heart failure and is scheduled for surgery with prolonged fasting. Which actions are appropriate? Select all that apply.

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> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client takes empagliflozin for heart failure and is scheduled for surgery with prolonged fasting. Which actions are appropriate? Select all that apply.

1Verify that empagliflozin is withheld for at least 3 days before the procedure when possible.
2Assess volume status, renal function, oral intake, and other ketoacidosis risk factors.
3Exclude ketoacidosis whenever the blood glucose is below 250 mg/dL.
4Check ketones and acid-base status if nausea, abdominal pain, dyspnea, or malaise occurs.
5Restart therapy only after the client is clinically stable and oral intake has resumed.
6Give an extra dose the night before surgery to preserve the heart-failure benefit.
7Restart empagliflozin in the postanesthesia care unit as soon as the procedure ends, even if the client remains fasting.
8Substitute a different SGLT2 inhibitor during the preoperative hold to preserve the heart-failure benefit.

## Explanation

Empagliflozin should be withheld for at least 3 days before surgery with prolonged fasting when possible, and ketoacidosis must be considered even without marked hyperglycemia.

## In-depth explanation

Quick answer
Prevent perioperative SGLT2-associated ketoacidosis and volume depletion.

Why this is correct
The current label identifies surgery, reduced intake, illness, and volume depletion as precipitating factors. Symptoms and acidosis matter even when glucose is not very high.

Easy analogy or mental picture
The glucose number can look calm while ketone production is building behind it.

Memory hook
SGLT2 plus fasting: hold 3 days, assess ketones by symptoms, restart after recovery.

NCLEX decision rule
Use clinical stability and resumed intake rather than the operation end time alone to guide restart.

Why the other choices are wrong
Normal-range glucose does not exclude ketoacidosis, and an extra preoperative dose increases risk.References
1DailyMed: JARDIANCEHeart-failure indication, perioperative hold, ketoacidosis recognition regardless of glucose, and safe restart conditions

## Clinical scenario

Perioperative SGLT2 screen
Track last dose, fasting, intake, volume status, renal function, glucose, ketones, bicarbonate, anion gap, symptoms, and restart criteria.

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