# Situation: An 80-year-old woman in a long-term care facility takes oral morphine daily for osteoarthritis pain and has chronic kidney disease with an estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73 m². She has not had a formed bowel movement in 6 days and has had no antibiotics in the past 3 months. The nurse reviews the Rome IV criteria for functional constipation used by the facility. Which finding counts toward the criteria?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630479  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: An 80-year-old woman in a long-term care facility takes oral morphine daily for osteoarthritis pain and has chronic kidney disease with an estimated glomerular filtration rate (eGFR) of 25 mL/min/1.73 m². She has not had a formed bowel movement in 6 days and has had no antibiotics in the past 3 months.

The nurse reviews the Rome IV criteria for functional constipation used by the facility. Which finding counts toward the criteria?

## 보기

1. Straining during at least one defecation each week
2. Hard stools that began within the past month
3. Straining in more than one-quarter of defecations **✔ 정답**
4. Fewer than 5 spontaneous bowel movements a week

**정답: 3**

## 해설

Rome IV functional constipation requires two or more of: straining, lumpy or hard stools, incomplete evacuation, anorectal blockage, or manual maneuvers (each in more than 25% of defecations), or fewer than 3 spontaneous bowel movements a week. Criteria must be met for the last 3 months with onset at least 6 months before diagnosis.

## 심화 해설

How Rome IV defines functional constipation
The Rome IV criteria for functional constipation require two or more of the following: straining, lumpy or hard stools, a sensation of incomplete evacuation, a sensation of anorectal blockage, or manual maneuvers to aid defecation, each occurring in more than 25% of defecations, or fewer than 3 spontaneous bowel movements per week. The criteria must be fulfilled for the last 3 months, with symptom onset at least 6 months before diagnosis. Straining counts only when it occurs in more than one-quarter of defecations, which is exactly what the correct option states.

Why the percentage matters
Almost everyone strains occasionally. Rome IV uses a frequency threshold so that a symptom is counted only when it is a regular feature of the person's bowel pattern. That is why the criteria are written as "more than 25% of defecations" rather than "ever" or "once a week." The same threshold applies to hard stools, incomplete evacuation, anorectal blockage, and manual maneuvers. The frequency criterion is separate and uses a fixed number: fewer than 3 spontaneous bowel movements a week.

| Option | Rome IV wording | Counts? |
| --- | --- | --- |
| Straining at least once a week | Straining in more than 25% of defecations | No |
| Hard stools began within the past month | Criteria met for 3 months, onset 6 months before | No |
| Straining in more than one-quarter of defecations | Matches the criterion | Yes |
| Fewer than 5 bowel movements a week | Fewer than 3 spontaneous bowel movements a week | No |

Applying the criteria to this client
This client takes oral morphine daily, so her constipation may be opioid-induced. Rome IV classifies opioid-induced constipation separately, and the nurse should report the opioid as a likely contributor. The question, however, asks only which finding counts toward the functional constipation criteria the facility uses, so the task is to recognize the correct wording. Watch out! Distractors change one detail: the frequency (once a week instead of more than 25%), the duration (1 month instead of 3 months with 6-month onset), or the number (5 instead of 3).

Exam takeaway
Memorize the structure: two or more symptoms, each in more than 25% of defecations, or fewer than 3 spontaneous bowel movements a week, present for 3 months with onset 6 months earlier. Key point! Rome IV criteria depend on precise thresholds; read every number in the option before choosing.

## 임상 시나리오

Rome IV Functional ConstipationWhich findings count toward the criteria
Two or more of: straining, lumpy or hard stools, incomplete evacuation, anorectal blockage, or manual maneuvers, each in more than 25% of defecations, or fewer than 3 spontaneous bowel movements a week.

Criteria must be met for the last 3 months with onset at least 6 months before diagnosis.

Daily morphine suggests an opioid contribution, which should be reported and addressed with a bowel regimen.

CautionOccasional straining, recent onset, or fewer than 5 bowel movements a week do not meet the Rome IV thresholds.

## 핵심 개념

- **Rome IV criteria** — International symptom-based criteria used to diagnose functional gastrointestinal disorders such as constipation and IBS.
- **Functional constipation** — Chronic constipation without a structural or biochemical cause, defined by Rome IV symptom and duration thresholds.
- **Spontaneous bowel movement** — A bowel movement that occurs without laxatives, enemas, suppositories, or manual help.
- **Opioid-induced constipation** — Constipation caused by opioids slowing gut motility and secretion, classified separately in Rome IV.

## 같은 주제 문제

- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630266)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630267)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630268)
- [Situation: A 52-year-old man with alcohol use disorder is admitted for poor oral intake. H…](https://mymerci.kr/pages/nclex_q.php?qn_id=630269)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630270)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630271)
- [Situation: A 46-year-old woman has had heartburn and regurgitation after meals for 6 month…](https://mymerci.kr/pages/nclex_q.php?qn_id=630272)
- [Situation: A 38-year-old man comes to the outpatient clinic with epigastric pain for the p…](https://mymerci.kr/pages/nclex_q.php?qn_id=630273)

---

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

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