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.

Understanding the Priority Setting
An 82-year-old patient with a hip fracture awaiting surgery presents with two interconnected problems: severe pain (8/10) and anxiety. In the NCLEX-RN framework, priority setting requires addressing the most immediate threat to the patient's physiological and psychological stability. Uncontrolled acute pain in an elderly patient is not merely a comfort issue; it triggers a cascade of harmful pathophysiological responses, including sympathetic nervous system activation, which increases heart rate, blood pressure, and myocardial oxygen demand. This is particularly dangerous in older adults who may have compromised cardiac function. Furthermore, the research evidence directly links preoperative psychological distress, including anxiety and fear, to worse postoperative outcomes. A study on preoperative surgical fear found that it is specifically associated with higher postoperative pain intensity and a lower quality of recovery after major joint surgery ^[3]. Therefore, the most critical and immediate nursing action is to break the pain-anxiety cycle by administering the prescribed analgesic and providing comfort measures.

Why Other Options Are Not the Priority
- Option 2 (Deep breathing and early mobilization): While deep breathing is a valuable non-pharmacological intervention for anxiety, it is insufficient as a sole intervention for severe pain rated 8/10. Early mobilization is contraindicated preoperatively for a non-surgically stabilized hip fracture due to the risk of displacement and further injury. Pain must be controlled first to enable any future participation in mobilization.
- Option 3 (Apply ice packs): Cold therapy can help reduce local inflammation and provide some analgesia, but it is an adjunctive measure, not the primary intervention for severe, acute pain in this context. Pharmacological management is the priority to achieve rapid and effective pain relief.
- Option 4 (High Fowler's position): This position is generally not recommended for a patient with a fractured hip as it can increase pressure and discomfort at the fracture site and does not address the underlying pain or anxiety.

The Critical Link Between Pain, Anxiety, and Surgical Outcomes
The rationale for prioritizing analgesic administration is strongly supported by the interconnected nature of pain and anxiety. A diagnostic model developed for elderly hip fracture patients highlights that trauma-related pain is a significant factor that complicates the diagnosis and screening of preoperative anxiety, which in turn significantly affects treatment prognosis . By effectively managing pain, the nurse simultaneously addresses a primary driver of the patient's anxiety. This integrated approach is crucial because a qualitative study on perioperative mental health interventions confirms that depression and anxiety can worsen surgical outcomes in older adults, underscoring the need for emotional health support that begins with basic comfort and pain control . Furthermore, a retrospective cohort study on older adults with hip fractures demonstrated that effective pain management strategies, such as continuous peripheral nerve blocks, are independently associated with reduced early opioid requirements . While the nurse in this scenario administers a prescribed analgesic, the principle is the same: early and aggressive pain control is a cornerstone of optimal perioperative care. Failing to prioritize pain management would leave the patient in a state of physiological stress, potentially complicating anesthesia induction and the postoperative recovery trajectory.