Editing Fundamentals of Nursing – RN Practice Questions (section)

==Question 9==
An older adult who has been immobile for several days and receiving opioids reports frequent small amounts of liquid brown stool. Which action should the nurse take first?
# Administer the prescribed antidiarrheal medication.
# Increase oral fluids and add fiber to the diet.
# Perform a focused abdominal and digital rectal assessment.
# Place the patient on contact precautions for suspected infection.

'''Answer:''' 3. Perform a focused abdominal and digital rectal assessment.

''Rationale:'' Liquid stool leaking around a hardened mass is the classic presentation of fecal impaction, a predictable consequence of immobility and opioid therapy. Assessment must come before intervention, and a focused abdominal and rectal examination identifies the impaction. Option 1 would worsen an impaction and is contraindicated until infection and impaction are ruled out. Option 2 is reasonable prevention but does not address the current problem and delays identification. Option 4 may become appropriate if infectious diarrhea is suspected, but the history here points strongly to impaction, and precautions are not the first assessment step.