A community health nurse is performing a vision screening on a 4-month-old infant. When shining a light source into the infant's visual field, which of the following is an expected finding?
The infant's eyes turn toward the light.
The infant's head turns away from the light.
The infant's eyes remain focused toward the floor.
The infant closes their eyes.
The Correct Answer is A
A.
A. The infant's eyes turn toward the light - This is the expected finding known as the "fixation reflex," where infants naturally turn their eyes toward a light source.
B. The infant's head turns away from the light - This would not be an expected finding during a vision screening; it may suggest a different reflex or issue.
C. The infant's eyes remain focused toward the floor - This would not be an expected finding during a vision screening; it may suggest a different visual or developmental concern.
D. The infant closes their eyes - Closing the eyes in response to light is not the typical response during a vision screening for infants.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Encouraging the client to gain 2.3 kg (5 lb) per week may be excessive and unrealistic, potentially contributing to feelings of failure and exacerbating the client's condition.
B. Weighing the client once per week throughout hospitalization is important for monitoring weight changes, but it does not specifically address the immediate post-meal monitoring needed to prevent complications such as purging.
C. Monitoring the client for 1 hr after meals helps prevent behaviors such as purging or other forms of compensatory behaviors that may occur immediately after eating.
D. Allowing the client to choose meal times may not be appropriate as it can perpetuate disordered eating patterns. Establishing regular meal times is important for promoting consistent eating habits.
Correct Answer is D
Explanation
- A) Utility: This principle is about producing the greatest good for the greatest number. In the case of a medication error, the focus is not on the collective good but on the individual patient's rights and well-being.
- B) Paternalism: This principle involves making decisions for others, potentially against their will, for their own good. It does not directly apply to the situation of a medication error where the patient's autonomy and right to be informed are paramount.
- C) Fidelity: This principle refers to loyalty and keeping one's promises. While important, it is secondary to the immediate need for honesty and transparency in the event of a medication error.
- D) Veracity: This principle obligates healthcare providers to tell the truth. When a medication error occurs, it is crucial to inform the patient about the mistake and the steps being taken to remedy it, making veracity the most applicable ethical principle in this scenario.
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