# Situation: A 50-year-old woman with beta-thalassemia trait comes to the clinic because of fatigue and frequent urination. She has hypertension and a body mass index (BMI) of 31 kg/m². She has no signs of acute illness. A year later, weekly semaglutide replaces her empagliflozin. She is scheduled for an elective operation under general anesthesia next week. Which action should the nurse take?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630498  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 50-year-old woman with beta-thalassemia trait comes to the clinic because of fatigue and frequent urination. She has hypertension and a body mass index (BMI) of 31 kg/m². She has no signs of acute illness.

A year later, weekly semaglutide replaces her empagliflozin. She is scheduled for an elective operation under general anesthesia next week. Which action should the nurse take?

## 보기

1. Give the weekly dose on the morning of the operation
2. Hold her metformin for 3 days before the operation
3. Tell the anesthesia team that she uses semaglutide **✔ 정답**
4. Stop semaglutide permanently because of the surgery

**정답: 3**

## 해설

Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide slow gastric emptying, which raises the risk of aspiration during anesthesia. The nurse informs the anesthesia team, and their preoperative instructions about fasting, a liquid diet, or holding doses are followed. Metformin is usually held only on the day of surgery.

## 심화 해설

Why the anesthesia team must know
Glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide lower glucose by enhancing insulin release, suppressing glucagon, and slowing gastric emptying. The slowed emptying is helpful for appetite and weight but becomes a hazard under general anesthesia: food can remain in the stomach even after a standard fasting period, increasing the risk of regurgitation and pulmonary aspiration during induction. The nurse's priority is to make sure the anesthesia team knows she uses semaglutide so they can plan her preoperative care.

What happens next
The anesthesia team decides how to manage the risk. Depending on current guidance and her situation, they may advise a clear liquid diet before surgery, a longer fasting period, holding a dose, or assessment of gastric contents before induction. The nurse follows their preoperative instructions and documents her last dose. Because semaglutide is weekly, the timing of the last injection relative to surgery matters, which is why this information must be communicated early rather than on the morning of the operation.

| Option | Problem |
| --- | --- |
| Give the weekly dose on the morning of surgery | Maximizes delayed gastric emptying at anesthesia |
| Hold metformin for 3 days | Metformin is usually held only on the day of surgery |
| Inform the anesthesia team | Correct; allows planning for aspiration risk |
| Stop semaglutide permanently | Unnecessary; the anesthesia team decides about holding doses |

Why the other actions are wrong
Giving the dose on the day of surgery would add to the slowed gastric emptying at the worst possible time. Holding metformin for 3 days is longer than needed; metformin is usually held on the day of surgery and restarted when she is eating and kidney function is stable. Stopping semaglutide permanently is not required and would remove an effective treatment for her diabetes and weight. Watch out! Nurses do not independently decide to hold or stop a long-acting drug before anesthesia; the key action is communication with the team that makes that decision.

Exam takeaway
Before any procedure with sedation or anesthesia, the nurse reviews all diabetes medicines, including injectables that clients may not think of as "pills." Key point! GLP-1 receptor agonists slow gastric emptying and raise aspiration risk; inform the anesthesia team and follow their instructions on fasting and dosing.

## 임상 시나리오

GLP-1 Receptor Agonists Before SurgeryAspiration risk and communication
Semaglutide slows gastric emptying, so food may remain in the stomach after normal fasting and raise the risk of aspiration under anesthesia.

Inform the anesthesia team of her weekly semaglutide and last dose; follow their instructions on fasting, a liquid diet, or holding doses.

Metformin is usually held only on the day of surgery.

CautionDo not give the weekly dose on the morning of the operation, and do not stop the drug permanently without an order.

## 핵심 개념

- **GLP-1 receptor agonist** — A drug such as semaglutide that mimics an incretin hormone, increasing insulin release and slowing gastric emptying.
- **Gastric emptying** — The movement of stomach contents into the small intestine.
- **Pulmonary aspiration** — Inhalation of stomach contents into the lungs, a serious risk during anesthesia induction.
- **Semaglutide** — A once-weekly injectable GLP-1 receptor agonist used for type 2 diabetes and weight management.

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