⚠️ Reduction of Risk · Lesson 1 of 6 · 6 min

The Pre-op Checklist: NPO, Consent, Jewelry, Void

📝 The client is on the stretcher, consent signed, IV running, ready to go. Then the nurse notices a wedding ring, acrylic nails and the fact that she ate a muffin at 0600. The case is cancelled. Every item on the checklist exists because of a cancelled or catastrophic case.

💡 Key idea

Consent before sedation, NPO as ordered, jewelry and dentures out, bladder empty, site marked, time-out done, and teach breathing exercises before, not after.

🧠 Why it matters

Confirm INFORMED CONSENT is signed before any sedative is given. Verify NPO status: typical guidance is no solid food for 6 to 8 hours and clear liquids until 2 hours before anesthesia, following the facility's orders. Remove JEWELRY (including piercings), DENTURES, contact lenses, hearing aids as instructed, and NAIL POLISH or acrylics on at least one finger for pulse oximetry. Have the client VOID before pre-medication. Apply the ID band and allergy band, verify the surgical SITE is marked by the surgeon with the client, and complete the surgical safety checklist with a TIME-OUT before incision. Review MEDICATIONS: anticoagulants and antiplatelets are usually held days before per order, metformin is held on the day of surgery, insulin is adjusted, and beta blockers are usually continued with a sip of water. Teach coughing, deep breathing, incentive spirometry, splinting and leg exercises before surgery, when the client can listen. Report an elevated temperature, a new cough or an abnormal lab such as a high potassium or a low hemoglobin; these can cancel a case.

🏥 In the real world

🍞 The client who ate the muffin is rescheduled. Annoyed, she asks why. The nurse explains that anesthesia relaxes the airway reflexes, and a full stomach can be aspirated into the lungs. The NPO rule is not a hospital inconvenience; it is the difference between a gallbladder surgery and an aspiration pneumonia.

📌 Takeaways

Consent must be signed before pre-medication
Remove jewelry, dentures, contacts; nail polish off for pulse oximetry
Hold anticoagulants per order and metformin the day of surgery; mark the site and time out

✅ Test yourself

A pre-operative client has already received IV midazolam when the nurse notices the consent form is unsigned. What should the nurse do?

Have the spouse sign for the client
Notify the surgeon
Proceed because the client agreed verbally earlier
Have the client sign now before the drug takes full effect

Answer: B · Notify the surgeon

Sedated clients cannot give informed consent. The surgeon must be notified and the case may need to be delayed.

Which pre-operative finding should the nurse report to the surgeon before the client goes to the operating room?

A hemoglobin of 14 g/dL
A potassium level of 4.2 mEq/L
A temperature of 38.6 °C (101.5 °F)
Mild anxiety about the procedure

Answer: C · A temperature of 38.6 °C (101.5 °F)

A fever may indicate infection and can lead to cancellation; the other findings are normal or expected.

When is the best time to teach a client to use an incentive spirometer?

Only if the client develops a fever
Before surgery, during pre-operative teaching
Immediately after surgery in the recovery room
On the second post-operative day

Answer: B · Before surgery, during pre-operative teaching

Clients learn best before surgery, when they are not in pain or sedated, and can then perform the exercises correctly afterward.

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