The practical nurse (PN) is assisting the recreational director of a long-term care facility in planning outdoor activities for wheelchair-bound older residents who are mentally alert. Which activity should the PN suggest that meets the physical and social needs of these residents?

Accommodation refers to the ability of the eyes to adjust and focus on objects at different distances. When a client's pupils constrict as they change focus from a far object to a near object, it indicates that their pupils are reacting appropriately to accommodate the change in focus.

To document this finding accurately, the practical nurse (PN) should document "Pupils reactive to accommodation." This statement captures the observation that the pupils are constricting in response to the client changing their focus from a far object to a near object. It indicates normal pupillary response and accommodation.

Let's briefly evaluate the other options:

A. Consensual pupillary constriction present.

Consensual pupillary constriction refers to the simultaneous constriction of both pupils when light is shone into one eye. This finding is not directly related to accommodation or the client's change in focus.

Therefore, it is not the appropriate documentation for the given scenario.

B. Nystagmus present with pupillary focus.

Nystagmus refers to involuntary eye movements that can affect the alignment and focus of the eyes. The presence of nystagmus is not mentioned in the scenario, and it is not directly related to the client's change in focus. Therefore, it is not the appropriate documentation for the given scenario.

D. Peripheral vision intact.

Peripheral vision refers to the ability to see objects outside the central visual field. While important for assessing visual function, it is not directly relevant to the observed pupillary response during accommodation. Therefore, it is not the appropriate documentation for the given scenario.

In summary, when a client's pupils constrict as they change focus from a far object to a near object, the practical nurse should document "Pupils reactive to accommodation" to accurately describe the observed pupillary response during the accommodation process.

This is the correct answer because it allows the practical nurse (PN) to assess the parents' knowledge and understanding of hypospadias, and to provide accurate and relevant information based on their needs.
Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis, but on the underside of the penis or in the scrotum²³. It is a common condition that affects about one in every 250 males at birth. Hypospadias does not resolve on its own and usually require surgical correction to prevent complications such as urinary tract infections, difficulty with urination and sexual function, and psychological distress¹². The PN should explain these facts to the parents and encourage them to discuss their concerns and questions with the health care provider. The PN should also provide emotional support and empathy to the parents, as they may feel anxious or guilty about their child's condition.