A 70-year-old male complains of ringing in the ears. The nurse describes this as:

A. Dilated pupils in response to dimmed lights are a normal response and not an indication of a

vision problem.

B. Pupils that remain dilated during an accommodation test indicate that the client may have an

issue with their autonomic nervous system and is not able to adjust their pupil size appropriately.

C. Far vision acuity of 20/20 bilaterally indicates normal vision.

D. A symmetrical pupillary light reflex response is a normal finding and not an indication of a vision

problem.

E. Frowning and squinting while reading the Snellen chart may indicate that the client is having difficulty seeing the letters clearly and may have a vision problem.

The nurse is assessing the 6 stages of the cardinal gaze to evaluate the function of the cranial nerves III, IV, and VI for ocular motor movements, which control eye movement and positioning.

Cranial nerve III controls the superior rectus, inferior rectus, and medial rectus muscles, which move the eye up, down, and inward, respectively. Cranial nerve IV controls the superior oblique muscle, which moves the eye downward and laterally. Cranial nerve VI controls the lateral rectus muscle, which moves the eye outward.

Therefore, the nurse will observe the patient's ability to move their eyes smoothly in each of the six cardinal positions of gaze and note any abnormalities that may indicate dysfunction of these cranial nerves. This test is used to diagnose conditions such as strabismus, nystagmus, and palsy of the ocular motor nerves.

Cranial nerve II, on the other hand, is responsible for visual acuity, not eye movement, and is tested separately using a visual acuity chart or other vision tests.