A client admitted after a head injury has documented longstanding anisocoria, with the left pupil larger but reactive. No eye medication was given. At the next check, the client is more drowsy. Click the new response that adds the strongest evidence of neurologic deterioration.

D. D shows the right pupil remaining 5 mm after light, a new loss of the earlier constriction.

The prior asymmetry alone is not new. Compare each eye with its own earlier response. The right pupil changes from 3-to-2 mm to 5-to-5 mm, while the left pupil still constricts. This change together with new drowsiness warrants urgent reassessment and escalation.

The observations are fictional teaching data. Apply the stated context; the selected feature does not by itself replace a complete bedside assessment.

Compare reactivity and each side’s baseline; unequal size alone is not the whole assessment.

Compare reactivity and each side’s baseline; unequal size alone is not the whole assessment.

A documents the known larger but reactive left pupil. B shows the earlier right response. C repeats the left response, so its larger initial size does not represent a new change. D is the new fixed response.

• New loss of pupillary reactivity despite baseline asymmetry — Compare reactivity and each side’s baseline; unequal size alone is not the whole assessment.
• Comparison with context — C starts with a pupil just as large as D but retains light reactivity.