A nurse is completing an assessment of a client who has increased intracranial pressure. Which of the following are expected findings? (Select all that apply.)

Stereotactic radiosurgery (SRS) is a highly precise, noninvasive radiation therapy used to treat brain tumors and vascular malformations. It works by focusing multiple beams of radiation on a single target to destroy abnormal cells without opening the skull. This therapy is particularly useful for small or inoperable tumors, as it minimizes damage to healthy brain tissue. SRS offers shorter recovery times and fewer complications compared to traditional brain surgery.

Rationale for correct answer:
B. Very precisely focused radiation destroys tumor cells: SRS delivers converging radiation beams that effectively target and kill tumor cells. It avoids the need for open craniotomy while preserving surrounding brain tissue.

Rationale for incorrect answers:

A. Radioactive seeds are implanted in the brain: This describes brachytherapy, which involves direct radioactive implantation rather than external focused radiation.

C. Tubes are placed to redirect CSF from one area to another: This is a shunt procedure for hydrocephalus and does not treat brain tumors.

D. The cranium is opened with removal of a bone flap to open the dura: This is a craniotomy, an invasive surgical procedure unlike the noninvasive SRS.

Take home points

• SRS is a noninvasive radiation therapy that destroys tumor cells without open surgery.
• Brachytherapy, shunts, and craniotomy are invasive procedures used for different purposes.
• Precision targeting in SRS reduces damage to healthy brain tissue and shortens recovery.

A positive Romberg sign indicates impaired balance or proprioception, which can occur with malignant brain tumors affecting the cerebellum or sensory pathways. To assess for this sign, the nurse evaluates the client’s ability to maintain posture and equilibrium with visual input removed. A positive result suggests that visual cues are compensating for poor proprioception, leading to swaying or loss of balance when the eyes are closed. This test helps identify neurological impairment that increases the client’s fall risk.

Rationale for correct answer:
D. Have the client stand erect with eyes closed. This position removes visual input, revealing balance or proprioception deficits. Swaying or falling indicates a positive Romberg sign.

Rationale for incorrect answers:

A. Stroke the lateral aspect of the sole of the foot. This elicits the Babinski reflex, which assesses upper motor neuron function, not balance.

B. Ask the client to blink his eyes. This assesses cranial nerve function (CN V and VII) but is unrelated to the Romberg test.

C. Observe for facial drooping. This evaluates facial nerve function and stroke symptoms, not proprioception or balance.

Take home points

• A positive Romberg sign indicates impaired balance due to cerebellar or sensory pathway dysfunction.
• Testing involves standing with eyes closed to assess reliance on visual cues for balance.
• Fall precautions are essential for clients with positive Romberg results.