Advanced Health Assessment Practice Exam

If the corneal light reflex is uneven in a 1-year-old, what should the nurse do next?

1. Perform the cover-uncover test

2. Refer the child for additional testing for strabismus

3. Test the pupils for consensual pupil constriction

4. Recheck at age 2

The correct answer is: Refer the child for additional testing for strabismus

In the scenario where the corneal light reflex is uneven in a 1-year-old, the most appropriate next step is to refer the child for additional testing for strabismus. An uneven corneal light reflex often indicates a potential misalignment of the eyes, which is referred to as strabismus. This condition can lead to amblyopia, or "lazy eye," if not addressed promptly. The referral for additional testing is crucial because early intervention can prevent long-term visual problems. In young children, developmental assessment of vision is critical, as their visual systems are still maturing. If strabismus is confirmed, appropriate management strategies, including potential surgical or therapeutic interventions, can be initiated. While performing the cover-uncover test is necessary for assessing eye alignment and is part of a comprehensive eye examination, the immediate priority after noticing an uneven corneal light reflex is to ensure the child receives a thorough evaluation by a specialist. Testing the pupils for consensual constriction is also relevant but does not directly address the concern of strabismus indicated by the uneven reflex. Rechecking at age 2 would be inadequate, as timely intervention is essential to prevent complications.