When the nurse asks a 68-year-old patient to stand with his feet together and arms at his side with his eyes closed, he starts to sway and moves his feet farther apart. How should the nurse document this finding?

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Quizplus · Accepted Answer

This is an abnormal, or positive, Romberg test. Abnormal findings for the Romberg test include swaying, falling, and a widening base of the feet to avoid falling. A positive Romberg sign is a loss of balance that is increased by the closing of the eyes. Ataxia is an uncoordinated or unsteady gait. Homan sign is used to test the legs for deep-vein thrombosis. Ataxia is an uncoordinated or unsteady gait. Homan sign is used to test the legs for deep-vein thrombosis. These findings are an abnormal, or positive, Romberg test. Abnormal findings for the Romberg test include swaying, falling, and a widening base of the feet to avoid falling.

When the Nurse Asks a 68-Year-Old Patient to Stand with His