A preschool aged client presents to the clinic with concerns for incontinence of stool. The nurse plans to assess the child to determine the cause of his encopresis. What is the priority assessment the nurse should perform?

Choice A rationale While bowel habits are a crucial part of the history, performing a thorough physical exam is the priority to rule out any immediate physical or structural cause, such as fecal impaction, before focusing on historical data. Fecal impaction is a common physical finding and cause of overflow incontinence, which must be assessed first. Choice B rationale Psychosocial factors are often contributing causes of encopresis, especially in cases where physical causes like chronic constipation have been ruled out. However, the first step must be a physical assessment to rule out the most common underlying physiological cause, which is often chronic constipation leading to impaction. Choice C rationale Nutritional history is important as poor intake of fiber and fluids contributes to chronic constipation, a major cause of encopresis. Nevertheless, the physical examination is the immediate priority to directly assess for the presence of a hard, palpable fecal mass or signs of chronic distension, which are objective findings. Choice D rationale The priority is to perform a physical exam, particularly a thorough abdominal and perianal assessment (including a rectal exam if indicated), to determine if the child is constipated and impacted with stool. Chronic constipation and fecal impaction, causing overflow incontinence, are the most common physical causes of encopresis that require immediate intervention. .