Choice C is correct. Asymmetrical pin-point lights on the pupils are a sign of strabismus. If the nurse suspects that the child has strabismus and conducts a corneal light reflex test, this may confirm her suspicions. This child should have a full eye exam performed to confirm the diagnosis and receive proper treatment.

Choice A is incorrect. A symmetrical pin-point light on each pupil is the normal finding in a corneal light reflex test. This is not a sign of strabismus, rather it is a normal finding.

Choice B is incorrect. The red reflex is a normal sign in healthy eyes. It occurs when light passes through the pupil and is reflected back off the retina to a viewing aperture, creating a reddish-orange glow.

Choice D is incorrect. Sun setting sign is an indication of increased intracranial pressure that presents when the eyes appear driven downward. The sclera is seen between the upper eyelid and the iris, and part of the lower pupil may be covered by the lower eyelid. The nurse does not assess for this sign with a corneal light reflex and it is not a sign of strabismus.

NCSBN Client Need Topic: Effective, safe care environment, Subtopic: Coordinated care; Pediatric - HEENT