The nurse is performing a middle ear assessment on a 15-year-old patient who has had a history of chronic ear infections. When examining the right tympanic membrane, the nurse sees the presence of dense white patches. The tympanic membrane is otherwise unremarkable. It is pearly, with the light reflex at 5 o'clock and landmarks visible. What should the nurse do?

A. Nystagmus in extreme superior gaze: A few beats of nystagmus in extreme lateral gaze may be normal, but sustained nystagmus, especially in superior gaze, suggests neurological impairment such as vestibular dysfunction or multiple sclerosis.

B. Slight amount of lid lag when moving the eyes from a superior to an inferior position: Lid lag, where the upper eyelid lags behind the downward movement of the eye, is often associated with hyperthyroidism (e.g., Graves' disease). It is not a normal finding in the diagnostic positions test.

C. Convergence of the eyes: Convergence is assessed when a person focuses on a near object, such as during an accommodation test. The diagnostic positions test evaluates extraocular muscle function and cranial nerves III, IV, and VI, focusing on coordinated movement rather than convergence.

D. Parallel/synchronized movement of both eyes: The normal finding in the diagnostic positions test is smooth, coordinated movement of both eyes in all six cardinal directions without lagging, misalignment, or significant nystagmus. This indicates intact extraocular muscles and proper cranial nerve function.

A. Bell palsy: Bell palsy is characterized by sudden, unilateral facial weakness or paralysis, usually affecting one side of the face. While it can impact sensation, the inability to differentiate between sharp and dull stimuli on both sides of the face suggests a more systemic issue rather than just Bell palsy.

B. Scleroderma: Scleroderma is a systemic autoimmune disease that affects connective tissue, leading to skin thickening and changes in blood flow. While it can cause skin changes and discomfort, it does not specifically result in the loss of the ability to differentiate sharp and dull sensations in a localized manner.

C. Damage to the trigeminal nerves: The trigeminal nerve (cranial nerve V) is responsible for sensory perception in the face, including the ability to differentiate between sharp and dull sensations. Damage to this nerve can lead to loss of sensation or altered sensation in the facial region. The bilateral nature of the symptoms suggests a central or systemic cause affecting the trigeminal pathways.

D. Frostbite with resultant paresthesia to the cheeks: Frostbite typically causes localized tissue damage and would more likely present with symptoms specific to the affected areas, such as numbness, discoloration, or blistering. While frostbite can lead to sensory changes, it would not typically result in a generalized inability to differentiate sensations on both sides of the face.