# An 82-year-old client with a fractured hip is scheduled for surgery in the morning. Which nursing intervention should be the priority during the preoperative period? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541030 > language: ko > subject: Adult Health ## 문제 An 82-year-old client with a fractured hip is scheduled for surgery in the morning. Which nursing intervention should be the priority during the preoperative period? The nurse is caring for an elderly client who fell at home and sustained a hip fracture. The client is experiencing severe pain and is scheduled for surgical repair. ## 보기 1. Administer prescribed pain medication every 4 hours as needed 2. Encourage the client to perform deep breathing exercises every hour 3. Apply ice packs to the affected hip for 20 minutes every 2 hours 4. Maintain proper body alignment and immobilize the affected extremity **✔ 정답** **정답: 4** ## 해설 Maintaining proper alignment and immobilization is priority to prevent fragment displacement and complications like fat embolism in a hip fracture patient awaiting surgery. Other interventions are secondary. ## 심화 해설 Clinical Context An 82-year-old client with a hip fracture is awaiting surgical repair. Hip fractures in older adults represent a time-critical, systemic condition characterized by frailty, multimorbidity, inflammation, immobility, and severe pain [1]. The preoperative period is not simply a waiting phase; it is a window for optimizing physiological stability to reduce the risk of medical complications and mortality [1]. In this scenario, the immediate threat to tissue integrity and systemic well-being stems from the mechanical instability of the fracture site. Priority Intervention Analysis The question asks for the priority nursing intervention. Using the nursing process and Maslow's hierarchy, physiological integrity and safety take precedence. While pain management, respiratory function, and cold therapy are all important, they address symptoms or secondary risks. The primary problem is the structural disruption of the femur, which directly threatens neurovascular status and can exacerbate pain, inflammation, and immobility through pathological movement. Correct Answer Rationale: Option 4 Maintaining proper body alignment and immobilizing the affected extremity is the priority intervention. This action directly addresses the root cause of several immediate threats: - Prevents secondary injury: Uncontrolled movement of fractured bone fragments can damage surrounding soft tissues, nerves, and blood vessels. - Reduces pain and inflammation: Immobilization eliminates the mechanical stimulation of pain fibers at the fracture site, which is a primary driver of the severe pain experience. This aligns with the concept that hip fracture is a state of inflammation and immobility [1]. - Minimizes complications: Stabilizing the fracture helps control local bleeding and edema, and it is a fundamental step in preparing the client for early surgical management, a strategy consistently supported by evidence to mitigate morbidity [1]. Incorrect Options Rationale - Option 1 (Administer pain medication): Pain management is critical, and evidence explores advanced techniques like continuous peripheral nerve blocks to reduce early opioid requirements . However, analgesia is a symptomatic intervention. Without first stabilizing the fracture, any movement will continue to trigger severe pain, making pain control less effective and requiring higher medication doses. Immobilization is a non-pharmacological pain management strategy that must be implemented first. - Option 2 (Deep breathing exercises): This intervention addresses a potential postoperative respiratory complication but is not the immediate physiological priority. The client's current crisis is musculoskeletal injury and severe pain, not an active respiratory impairment. This is a secondary prevention measure. - Option 3 (Apply ice packs): Cold therapy is an adjunctive comfort measure to reduce local swelling and provide analgesia. It does not, however, address the critical need for fracture stabilization. Applying ice without proper immobilization would be ineffective and could cause further displacement and pain during application. Pathophysiological and Clinical Reasoning The clinical priority is grounded in the understanding that a hip fracture initiates a cascade of local and systemic responses. Locally, the unstable fracture causes direct tissue trauma with each movement, intensifying the inflammatory response and pain [1]. Systemically, this pain and inflammation contribute to the frailty and high-risk state of the older adult [1]. By ensuring proper alignment and immobilization, the nurse directly halts this mechanical provocation. This nursing action creates the physiological stability required for all other interventions—including pain assessment, medication administration, and respiratory exercises—to be safe and effective. It directly supports the overarching goal of optimizing the patient for early surgery, which is the definitive management to reduce mortality and complications [1].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 ImmobilizationPriority Nursing Intervention for Elderly Patients For an older adult with a hip fracture awaiting surgery, the priority intervention is to maintain proper body alignment and immobilize the affected extremity. This directly prevents secondary neurovascular injury from bone fragment movement and reduces pain at its source. Use pillows, trochanter rolls, or light splinting to keep the leg in neutral alignment. Avoid aggressive movement. Perform a neurovascular check (pulses, sensation, movement, color, temperature) every 1-2 hours to detect early signs of compartment syndrome or vascular compromise. CautionNever attempt to forcefully realign or rotate the leg. Immobilization is a temporary stabilization measure until surgical repair. Pain medication and ice are important supportive measures but do not replace the safety provided by fracture immobilization. ## 핵심 개념 - **Preoperative Optimization** — A proactive process of assessing and managing a surgical patient's medical conditions and physiological reserve before surgery to improve outcomes. - **Hip Fracture Immobilization** — The use of positioning aids, traction, or splinting to prevent movement at the fracture site, protecting neurovascular structures and reducing pain. - **Neurovascular Assessment** — Evaluation of nerve and blood vessel function distal to an injury, typically checking pulses, sensation, movement, color, and temperature. - **Priority Setting (Maslow's Hierarchy)** — A framework for clinical decision-making that prioritizes physiological needs and physical safety over other psychosocial or secondary concerns. ## 같은 주제 문제 - [A 78-year-old client is admitted to the emergency department after falling at home. The cl…](https://mymerci.kr/pages/nclex_q.php?qn_id=541028) - [A 78-year-old client is admitted to the emergency department after falling at home. The cl…](https://mymerci.kr/pages/nclex_q.php?qn_id=541029) - [A 78-year-old client is admitted to the orthopedic unit following surgical repair of a fra…](https://mymerci.kr/pages/nclex_q.php?qn_id=541031) - [An 82-year-old patient with a fractured hip is scheduled for surgery in 2 hours. The patie…](https://mymerci.kr/pages/nclex_q.php?qn_id=541032) - [A 65-year-old client with a fractured hip is scheduled for surgery in the morning. Which n…](https://mymerci.kr/pages/nclex_q.php?qn_id=541033) - [A 78-year-old patient with a fractured hip is scheduled for surgery tomorrow morning. Whic…](https://mymerci.kr/pages/nclex_q.php?qn_id=541034) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._