A nurse is reviewing the health record of a client who has a malignant brain tumor and notes the client has a positive Romberg sign. Which of the following actions should the nurse take to assess for this sign?

A benign brain tumor is a noncancerous growth that develops only within the brain tissue and does not metastasize to other parts of the body. Unlike malignant tumors, benign tumors grow slowly and remain localized, though they can still cause significant neurological symptoms by compressing brain structures. Educating the client about the localized nature of benign brain tumors helps reduce anxiety and clarify the difference from metastatic disease. Treatment focuses on surgical removal or monitoring rather than systemic therapy.

Rationale for correct answer:
C. “It is limited to brain tissue.” Benign brain tumors do not spread outside the central nervous system. They are localized growths that remain within the brain.

Rationale for incorrect answers:

A. “It can spread to breasts and kidneys.” Benign brain tumors do not metastasize to other organs. This pattern is only seen with malignant or metastatic cancers.

B. “It can develop in your gastrointestinal tract.” Benign brain tumors do not spontaneously appear in other organ systems. Tumors in the GI tract would have a separate origin.

D. “It probably started in another area of your body and spread to your brain.” This describes metastatic brain cancer, not a benign primary brain tumor. Benign tumors originate in the brain itself.

Take home points

• Benign brain tumors remain localized and do not metastasize to other organs.
• They can still cause serious neurological effects by compressing surrounding tissue.
• Patient education reduces anxiety and helps distinguish benign from metastatic disease.

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.