The nurse is performing the diagnostic positions test. Which result is a normal finding?

The diagnostic positions test, or the six cardinal positions of gaze, evaluates the functional integrity of the extraocular muscles and cranial nerves III, IV, and VI. Normal ocular motility requires conjugate movement, where both eyes track a target simultaneously and smoothly. Any uncoordinated deviation or restricted movement suggests muscular weakness or neurological impairment within the brainstem or nerves. A. Parallel movement of both eyes: A normal result is characterized by the eyes moving in a conjugate, parallel fashion as they follow the object through all six positions. This indicates that the cranial nerves and all six extraocular muscles are functioning harmoniously. There should be no lagging or misalignment during the transition between gazes. B. Slight amount of lid lag when moving the eyes: Lid lag occurs when the superior eyelid does not follow the downward movement of the globe, exposing a strip of sclera. This is a characteristic clinical sign of hyperthyroidism or Graves disease. In a healthy individual, the eyelid should overlap the superior limbus throughout the movement. C. Nystagmus in downward gaze: Nystagmus is an involuntary, rhythmic oscillation of the eyes that is generally pathological when occurring in most directions. While a few beats of horizontal nystagmus at extreme lateral gaze can be normal, nystagmus during downward gaze is an abnormal finding. It often indicates vestibular or cerebellar dysfunction. D. Convergence of the eyes: Convergence is the simultaneous inward movement of both eyes toward the midline to maintain single binocular vision when viewing a near object. While a normal reflex, it is not the focus of the diagnostic positions test. This specific test is designed to assess version and muscle balance.