An 82-year-old patient with a fractured hip is scheduled for surgery in 2 hours. The patient reports severe pain (8/10) and appears anxious. Which nursing intervention should be the priority?

Pain management is the priority for a patient with severe pain (8/10) and anxiety preoperatively, as uncontrolled pain can lead to complications and interfere with preparation. Other interventions like breathing exercises or positioning are important but secondary to immediate pain relief.

Core Nursing Explanation Key Concept Analysis: This question assesses the ability to prioritize nursing interventions using the Maslow's Hierarchy of Needs and the Nursing Process. The core theme is managing a patient's preoperative needs. The patient has two primary issues: severe pain (8/10) and anxiety. From a pathophysiological perspective, severe pain activates the sympathetic nervous system ("fight-or-flight" response), leading to increased heart rate, blood pressure, and stress hormone levels (e.g., cortisol). This physiological state can increase the risk of Key Point! preoperative complications such as cardiac ischemia, poor wound healing, and can also exacerbate anxiety, creating a vicious cycle. Effective pain management is a fundamental physiological need and a prerequisite for the patient to cooperate with other preoperative preparations.

Answer Rationale: The priority intervention is Administer prescribed analgesic medication and provide comfort measures. Key Point! In the immediate preoperative period (

Nursing Clinical Practice Guide Clinical Scenario: You are the nurse on an orthopedic unit. Mr. Johnson, an 82-year-old with a history of osteoporosis, fell at home and was admitted with a right femoral neck fracture. He is scheduled for an open reduction internal fixation (ORIF) in two hours. He is clutching the side rail, grimacing, and rates his pain as 8/10. He states, "I'm so scared about this surgery."

Nursing Intervention Strategy:

1. Assessment (First & Ongoing):
   • Pain: Use PQRST or OLDCARTS to assess characteristics. Check vital signs (tachycardia, hypertension may indicate pain/stress).
   • Neurovascular Status of the affected limb: Check pulses (dorsalis pedis, posterior tibial), capillary refill, sensation, movement, and temperature. Compare to unaffected side. This is a baseline assessment critical for postoperative comparison.
   • Anxiety: Assess level and contributing factors (fear of surgery, pain, loss of independence).
2. Immediate Intervention (Priority):
   • Administer the prescribed opioid analgesic (e.g., morphine 2-4 mg IV). IV route is preferred preoperatively for rapid onset and predictable absorption.
   • While preparing/administering, use therapeutic communication: "Mr. Johnson, I'm going to give you medication for your pain right now. It should start working in a few minutes. I'll stay with you."
   • Provide simple comfort measures: Ensure the bed is in a safe, low position; adjust lighting; offer a cool cloth to his forehead.
3. Reassessment & Preparation:
   • Reassess pain in 15-30 minutes after IV medication. Goal is to reduce pain to a tolerable level (e.g., 3-4/10).
   • Once pain is better controlled, you can proceed with other preoperative tasks: verify consent, ensure NPO status, perform skin prep, administer preoperative antibiotics if ordered, and provide brief, calm explanations of what to expect.
   • Address anxiety with clear, concise information and emotional support. "The anesthesiologist will be here soon to talk with you. They will make sure you are asleep and comfortable during the procedure."

Patient Safety and Precautions:

• Fracture Immobilization: Do not move or turn the patient without proper support (e.g., using a trapeze, log-rolling if necessary). The leg may be in traction or a splint.
• Medication Safety: In the elderly, start with lower doses of opioids due to reduced metabolism. Monitor closely for oversedation, respiratory depression (rate