A nurse in a long-term care facility is collecting data from a client who reports fullness in the rectum and abdominal cramping. Which of the following findings should indicate to the nurse that the client might have a fecal impaction?

Fecal impaction occurs when a large, hardened mass of stool becomes lodged in the rectum and cannot be expelled normally. A classic and often counterintuitive sign of fecal impaction is the passage of small amounts of liquid stool. This occurs because liquid stool from higher in the colon seeps around the impacted mass and leaks out, giving the appearance of liquid diarrhea. This can be misleading if the nurse interprets it as loose stools rather than recognizing it as a sign of obstruction. The client's reported symptoms — fullness in the rectum and abdominal cramping — are consistent with impaction, and the liquid stool finding confirms it. Halitosis can occur in many conditions, including constipation, but is a nonspecific finding not diagnostic of impaction. Hemorrhoids are associated with straining during defecation and may coexist with constipation, but they are not a specific indicator of fecal impaction. Rebound tenderness is a peritoneal sign associated with inflammation or perforation, not a characteristic finding of fecal impaction. Small liquid stools are the hallmark clinical clue that should prompt the nurse to assess for impaction.