# A 78-year-old patient with osteoporosis fell at home and sustained a hip fracture. The patient is scheduled for surgical repair tomorrow morning. Which nursing action should be the HIGHEST priority during the preoperative period?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541005  
> language: ko  
> subject: Adult Health

## 문제

A 78-year-old patient with osteoporosis fell at home and sustained a hip fracture. The patient is scheduled for surgical repair tomorrow morning. Which nursing action should be the HIGHEST priority during the preoperative period?

## 보기

1. Administer prescribed pain medication every 4 hours as needed
2. Maintain proper body alignment and immobilize the affected extremity **✔ 정답**
3. Encourage deep breathing exercises and use of incentive spirometer
4. Assess neurological status and perform frequent vital sign monitoring

**정답: 2**

## 해설

Maintaining proper body alignment and immobilization is the highest priority to prevent further injury, displacement, and complications like fat embolism or neurovascular compromise. Pain management, respiratory care, and monitoring are important but secondary to immediate safety.

## 심화 해설

Understanding the Priority: Why Immobilization Comes First

For a patient with a hip fracture awaiting surgery, the immediate postoperative goal is to prevent further injury and reduce the risk of life-threatening complications. While all the listed nursing actions are important, maintaining proper body alignment and immobilizing the affected extremity is the highest priority because it directly addresses the most urgent threats: neurovascular compromise, severe pain, and fat embolism.

The rationale is rooted in the pathophysiology of the fracture itself. A hip fracture is not a clean break; the fractured bone ends are sharp and surrounded by a rich network of blood vessels and nerves. Any movement of the fracture fragments can lacerate these vessels, leading to increased bleeding and hematoma formation, and can cause direct nerve injury. More critically, movement can force fat globules from the bone marrow into the torn venous sinuses, creating a fat embolism, a life-threatening complication that can obstruct pulmonary or cerebral circulation. The provided evidence highlights that hip fracture in older adults is a "systemic condition" characterized by "immobility, pain, and high risk of medical complications" [1]. The first and most direct nursing intervention to mitigate these immediate mechanical risks is stabilization of the fracture site.

Analyzing the Options Through a Clinical Lens

Let's examine why the other options, while essential, are secondary to immobilization in the immediate preoperative phase.

- Option 1: Administer prescribed pain medication. Pain management is a core nursing responsibility. However, a significant component of the patient's pain is caused by muscle spasm and the movement of unstable bone fragments. Proper immobilization and alignment are powerful non-pharmacological pain-relief measures that address the root cause of the pain. Administering medication without first stabilizing the limb is less effective and may mask a worsening condition, such as a developing compartment syndrome. The research underscores the importance of optimizing care pathways to mitigate morbidity, and stabilization is the foundational step [1].

- Option 3: Encourage deep breathing and incentive spirometry. This intervention targets the prevention of postoperative pulmonary complications like atelectasis and pneumonia. While crucial for a frail, older adult on bed rest, it is not the most immediate physiological threat. The risk of respiratory decline is a subacute concern that builds over days, whereas neurovascular injury or fat embolism from an unstabilized fracture can occur within minutes to hours. Prophylactic pulmonary care is a high priority but is initiated after the limb is safely secured.

- Option 4: Assess neurological status and frequent vital signs. This is a critical component of ongoing monitoring. However, a comprehensive neurovascular assessment (checking pulses, capillary refill, sensation, and motor function distal to the fracture) is performed to evaluate the effectiveness of immobilization and to detect early signs of complications like compartment syndrome. The assessment itself does not prevent the injury; the action of immobilization does. Frequent vital sign monitoring is essential for detecting systemic complications like hemorrhage or fat embolism, but the first nursing action to prevent these is to stabilize the fracture. The Caprini risk assessment model study reinforces that we must actively implement preventive measures, not just monitor for their failure, particularly given the high risk of venous thromboembolism in this population . Immobilization is the foundational preventive action that makes the subsequent monitoring meaningful.

Clinical Integration: The "Why" Behind the Action

In the context of an older adult with a hip fracture, the concept of "time-critical" management is paramount [1]. The preoperative period is not a passive waiting phase but an active window for optimization and risk reduction. The nursing action of immobilization directly supports the goal of early surgical management by preventing secondary injury that could delay surgery or worsen the patient's physiological state. It involves placing the affected leg in slight abduction with a pillow or splint, using a trochanter roll to prevent external rotation, and avoiding any active or passive movement of the hip joint. This action stabilizes the fracture, minimizes bleeding, reduces the risk of fat embolism, and provides significant pain relief, thereby stabilizing the patient's overall condition and preparing them safely for the operating room. The high risk of deep venous thrombosis (DVT) in this population, as highlighted in the Caprini model study, further underscores the need for strict immobility of the fracture site to avoid dislodging any early clot that may be forming .References (research sources)

- [1]Management and optimisation in the preoperative phase for patients with a fractured hip.Research articleMeermans G, van Egmond JC. (2026) · DOI: 10.1530/eor-2026-0044

## 임상 시나리오

Preoperative Hip Fracture ManagementPriority Nursing Action: Immobilization
For a patient awaiting surgery, the highest priority is to maintain proper body alignment and immobilize the affected extremity. This directly prevents the sharp bone fragments from lacerating vessels or nerves and reduces the risk of fat embolism.

Use gentle traction or positioning aids as ordered. Avoid sudden movements or logrolling without adequate support. Assess neurovascular status (pulses, sensation, movement) immediately after immobilization and frequently thereafter.

CautionDo not delay immobilization for pain medication administration. Movement of an unstabilized hip fracture can precipitate a life-threatening fat embolism or cause severe neurovascular injury. Immobilization itself is a powerful pain-reduction intervention.

## 핵심 개념

- **Fat Embolism Syndrome** — A life-threatening complication where fat globules from bone marrow enter the bloodstream, often after long bone fractures, causing respiratory distress and petechiae.
- **Neurovascular Compromise** — Injury to the nerves and blood vessels surrounding a fracture site, often caused by movement of sharp bone fragments, leading to ischemia or nerve damage.
- **Preoperative Immobilization** — The stabilization of a fractured extremity before surgery using traction, splints, or proper positioning to prevent further soft tissue injury.

## 같은 주제 문제

- [A nurse is assessing a client with a suspected fracture of the femur. Which assessment fin…](https://mymerci.kr/pages/nclex_q.php?qn_id=540972)
- [A nurse is assessing a client with a suspected fracture of the femur. Which assessment fin…](https://mymerci.kr/pages/nclex_q.php?qn_id=540975)
- [A 68-year-old patient with a suspected hip fracture is brought to the emergency department…](https://mymerci.kr/pages/nclex_q.php?qn_id=540993)
- [A nurse is assessing a 45-year-old construction worker who fell from scaffolding 2 hours a…](https://mymerci.kr/pages/nclex_q.php?qn_id=540994)
- [A 55-year-old patient with a suspected hip fracture is brought to the emergency department…](https://mymerci.kr/pages/nclex_q.php?qn_id=540995)
- [A 72-year-old patient with osteoporosis fell at home and is suspected of having a hip frac…](https://mymerci.kr/pages/nclex_q.php?qn_id=540996)
- [A 45-year-old client with a history of osteoporosis is admitted to the emergency departmen…](https://mymerci.kr/pages/nclex_q.php?qn_id=540997)
- [A 68-year-old patient with a displaced femoral neck fracture is scheduled for hip replacem…](https://mymerci.kr/pages/nclex_q.php?qn_id=540998)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._