Neuro 2 Flashcards
A nurse is educating a group about stroke risk factors. Which modifiable risk factor should be emphasized?
A. Age over 65
B. Family history of stroke
C. Hypertension
D. History of transient ischemic attack (TIA)
Correct Answer: C. Hypertension
Rationale: Hypertension is the most significant modifiable risk factor for stroke. While age and family history are non-modifiable, controlling blood pressure greatly reduces stroke risk.
A patient presents with slurred speech, right-sided weakness, and difficulty understanding speech. Symptoms resolve within an hour. The nurse suspects which condition?
A. Ischemic stroke
B. Transient ischemic attack (TIA)
C. Hemorrhagic stroke
D. Subarachnoid hemorrhage
Correct Answer: B. Transient ischemic attack (TIA)
Rationale: A TIA is a temporary episode of neurological dysfunction lasting less than an hour without causing permanent damage. It is a warning sign of an impending stroke.
A patient with an embolic stroke is most likely to have a history of which condition?
A. Atrial fibrillation
B. Hypertension
C. Hyperlipidemia
D. Diabetes mellitus
Correct Answer: A. Atrial fibrillation
Rationale: Atrial fibrillation increases the risk of embolism by promoting clot formation in the heart, which can travel to the brain and cause an embolic stroke.
A patient with a suspected stroke arrives at the emergency department. What is the nurse’s priority intervention?
A. Start IV fluids
B. Obtain a CT scan of the head
C. Administer aspirin
D. Check blood glucose levels
Correct Answer: B. Obtain a CT scan of the head
Rationale: A CT scan must be performed immediately to differentiate ischemic from hemorrhagic stroke, which determines treatment. Anticoagulants are contraindicated in hemorrhagic strokes.
A nurse is preparing to administer alteplase (tPA) to a patient with an ischemic stroke. Which finding would require the nurse to withhold the medication?
A. Blood pressure of 168/90 mmHg
B. Stroke symptom onset 2.5 hours ago
C. History of atrial fibrillation
D. Recent gastrointestinal bleeding
Correct Answer: D. Recent gastrointestinal bleeding
Rationale: Alteplase (tPA) is contraindicated in patients with recent bleeding (GI bleed, surgery, trauma) due to the high risk of hemorrhage.
Which symptom is most characteristic of a right-hemispheric stroke?
A. Expressive aphasia
B. Right-sided paralysis
C. Impulsive behavior
D. Impaired language comprehension
Correct Answer: C. Impulsive behavior
Rationale: Right hemisphere strokes often cause impulsivity, poor judgment, and lack of awareness of deficits. Language impairment is more common in left hemisphere strokes.
A patient with increased intracranial pressure (ICP) is prescribed mannitol. What is the expected outcome?
A. Reduced cerebral edema
B. Increased blood pressure
C. Decreased urine output
D. Increased respiratory rate
Correct Answer: A. Reduced cerebral edema
Rationale: Mannitol is an osmotic diuretic that reduces cerebral edema by pulling fluid from the brain into circulation, increasing urine output.
A nurse is caring for a patient recovering from a hemorrhagic stroke. Which intervention is contraindicated?
A. Administering stool softeners
B. Monitoring blood pressure
C. Administering anticoagulants
D. Elevating the head of the bed
Correct Answer: C. Administering anticoagulants
Rationale: Anticoagulants (e.g., heparin, warfarin, aspirin) are contraindicated in hemorrhagic strokes because they increase the risk of further bleeding.
A nurse is assessing a patient with a left-sided stroke. Which finding is expected?
A. Right-sided hemiplegia
B. Impulsivity and poor judgment
C. Spatial-perceptual deficits
D. Left-sided neglect
Correct Answer: A. Right-sided hemiplegia
Rationale: The left hemisphere controls the right side of the body, so left-sided strokes cause right-sided weakness or paralysis.
A patient with dysphagia after a stroke is at risk for aspiration. Which intervention should the nurse implement?
A. Position the patient in high-Fowler’s during meals
B. Offer thin liquids to encourage hydration
C. Encourage the patient to eat quickly to avoid fatigue
D. Allow the patient to use a straw for liquids
Correct Answer: A. Position the patient in high-Fowler’s during meals
Rationale: High-Fowler’s position (sitting upright) reduces the risk of aspiration. Thin liquids and straws should be avoided as they increase aspiration risk.
A nurse is educating a patient about modifiable stroke risk factors. Which statement indicates the patient understands the teaching?
A. “I can’t do anything about my stroke risk.”
B. “I will monitor my blood pressure regularly.”
C. “I should avoid taking my cholesterol medication.”
D. “I don’t need to stop smoking since I feel fine.”
Correct Answer: B. “I will monitor my blood pressure regularly.”
Rationale: Hypertension is a major modifiable risk factor for stroke. Blood pressure control is essential for stroke prevention.
A patient is receiving IV fluids after a stroke. Which IV solution should be avoided?
A. 0.9% Normal Saline
B. Lactated Ringer’s
C. Dextrose 5% in water (D5W)
D. 0.45% Normal Saline
Correct Answer: C. Dextrose 5% in water (D5W)
Rationale: D5W is a hypotonic solution that can worsen cerebral edema and increase intracranial pressure (ICP). Isotonic fluids (e.g., NS, LR) are preferred.
A nurse is assessing a patient with a stroke affecting the cerebellum. Which symptom is expected?
A. Difficulty swallowing
B. Impaired balance and coordination
C. Expressive aphasia
D. Hemiplegia
Correct Answer: B. Impaired balance and coordination
Rationale: The cerebellum controls balance and coordination, so damage results in ataxia, dizziness, and difficulty walking
A patient with a stroke is experiencing unilateral neglect. What is the best nursing intervention?
A. Encourage the patient to ignore the affected side
B. Place objects on the affected side to encourage use
C. Avoid touching the affected side
D. Turn the patient’s head toward the unaffected side
Correct Answer: B. Place objects on the affected side to encourage use
Rationale: Unilateral neglect causes the patient to ignore one side of the body. Placing objects on the affected side encourages awareness and use.
A nurse is assessing a patient with a suspected hemorrhagic stroke. Which symptom is most indicative of this condition?
A. Sudden, severe headache
B. Gradual onset of unilateral weakness
C. Numbness and tingling in the extremities
D. Transient loss of consciousness
Correct Answer: A. Sudden, severe headache
Rationale: A sudden, severe headache (“thunderclap headache”) is a hallmark sign of hemorrhagic stroke, caused by intracranial bleeding and increased intracranial pressure (ICP).
A patient with increased intracranial pressure (ICP) is placed in a semi-Fowler’s position. What is the rationale for this intervention?
A. It increases cerebral blood flow
B. It prevents aspiration pneumonia
C. It promotes venous drainage from the brain
D. It decreases the risk of brain herniation
Correct Answer: C. It promotes venous drainage from the brain
Rationale: Elevating the head of the bed (HOB) to 25-30 degrees helps reduce ICP by promoting venous drainage, preventing further brain swelling.
A nurse is preparing to administer tissue plasminogen activator (tPA) for a patient with an ischemic stroke. Which factor is a contraindication?
A. Blood pressure of 170/90 mmHg
B. Onset of stroke symptoms 2.5 hours ago
C. History of peptic ulcer disease
D. Active gastrointestinal (GI) bleeding
Correct Answer: D. Active gastrointestinal (GI) bleeding
Rationale: tPA is contraindicated in patients with active bleeding, recent surgery, or a history of intracranial hemorrhage due to the risk of excessive bleeding.
A patient with a stroke has difficulty understanding spoken and written language but can speak fluently. This condition is known as:
A. Broca’s aphasia
B. Wernicke’s aphasia
C. Dysarthria
D. Global aphasia
Correct Answer: B. Wernicke’s aphasia
Rationale: Wernicke’s aphasia (receptive aphasia) affects language comprehension but allows fluent speech that lacks meaning. Broca’s aphasia impairs speech production but preserves comprehension.
A patient with a history of stroke is experiencing neglect of their left side. Which nursing intervention is most appropriate?
A. Encourage the patient to look toward the left side
B. Place the call light and personal items on the right side
C. Approach the patient from the right side
D. Avoid turning the patient’s head to the left
Correct Answer: A. Encourage the patient to look toward the left side
Rationale: Unilateral neglect occurs when a patient ignores one side of the body. Encouraging scanning the affected side helps improve awareness and function.
A nurse is monitoring a patient for complications of increased intracranial pressure (ICP). Which finding requires immediate intervention?
A. Widening pulse pressure and irregular respirations
B. Decreased deep tendon reflexes
C. Glasgow Coma Scale (GCS) score of 14
D. Pupils equal and reactive to light
Correct Answer: A. Widening pulse pressure and irregular respirations
Rationale: Widening pulse pressure, irregular respirations (Cheyne-Stokes), and bradycardia are signs of Cushing’s triad, indicating brainstem herniation, which is a medical emergency.
A patient with a suspected embolic stroke is admitted to the emergency department. Which diagnostic test should be performed first?
A. Magnetic resonance angiography (MRA)
B. Non-contrast computed tomography (CT) scan
C. Transcranial Doppler ultrasonography
D. Cerebral angiography
Correct Answer: B. Non-contrast computed tomography (CT) scan
Rationale: A non-contrast CT scan is the first-line imaging test for stroke to differentiate between ischemic and hemorrhagic stroke, guiding treatment decisions.
A nurse is providing discharge teaching to a patient who had a stroke. Which statement by the patient requires further teaching?
A. “I should monitor my blood pressure regularly.”
B. “I will continue my smoking cessation plan.”
C. “I don’t need to take my blood thinners if I feel fine.”
D. “I will follow a low-fat, low-sodium diet.”
Correct Answer: C. “I don’t need to take my blood thinners if I feel fine.”
Rationale: Anticoagulants and antiplatelets (e.g., aspirin, warfarin) must be taken consistently to prevent another stroke, even if the patient feels fine.
A patient is diagnosed with a stroke affecting the middle cerebral artery (MCA). Which symptom is most likely?
A. Loss of coordination and balance
B. Visual field deficits and hemiparesis
C. Difficulty swallowing and speaking
D. Complete loss of sensation in lower limbs
Correct Answer: B. Visual field deficits and hemiparesis
Rationale: MCA strokes commonly cause contralateral hemiparesis, sensory deficits, and visual disturbances. The MCA supplies a large portion of the brain.
A patient with a subarachnoid hemorrhage is at high risk for vasospasm. Which intervention is most appropriate?
A. Administer calcium channel blockers
B. Lower the head of the bed to improve perfusion
C. Increase IV fluids to induce hypertension
D. Withhold pain medications to monitor for neurologic changes
Correct Answer: A. Administer calcium channel blockers
Rationale: Nimodipine (a calcium channel blocker) is commonly used to prevent cerebral vasospasm, which can lead to secondary ischemia after a subarachnoid hemorrhage
A patient with increased intracranial pressure (ICP) is receiving mannitol therapy. Which finding requires immediate intervention?
A. Increased urine output
B. Serum sodium level of 140 mEq/L
C. Crackles in the lungs and dyspnea
D. Decreased intracranial pressure on monitoring
Correct Answer: C. Crackles in the lungs and dyspnea
Rationale: Crackles and dyspnea suggest pulmonary edema, a serious complication of mannitol therapy due to fluid shifts. Immediate intervention is needed to prevent respiratory distress.
A nurse is planning care for a patient in the acute phase of a stroke. Which intervention is most important to prevent aspiration?
A. Keep the patient in a supine position
B. Perform a swallowing assessment before oral intake
C. Offer thin liquids to encourage hydration
D. Encourage the patient to eat quickly to prevent fatigue
Correct Answer: B. Perform a swallowing assessment before oral intake
Rationale: Dysphagia (swallowing difficulty) is common after a stroke and increases the risk of aspiration pneumonia. A swallowing assessment (by speech therapy) should be done before the patient eats or drinks.
A patient is prescribed warfarin after an ischemic stroke. Which statement by the patient indicates a need for further teaching?
A. “I will have my INR checked regularly.”
B. “I will eat a consistent amount of leafy green vegetables.”
C. “I can take ibuprofen for headaches if needed.”
D. “I will report any unusual bruising or bleeding to my provider.”
Correct Answer: C. “I can take ibuprofen for headaches if needed.”
Rationale: NSAIDs (like ibuprofen) increase bleeding risk when taken with warfarin. Patients should use acetaminophen (Tylenol) instead and notify their provider before taking any new medications.
A patient recovering from a stroke has right-sided weakness and difficulty dressing. What is the most appropriate nursing intervention?
A. Encourage the patient to dress their weak side first
B. Have the nurse dress the patient completely
C. Place all clothing on the left side of the bed
D. Advise the patient to avoid dressing until full mobility returns
Correct Answer: A. Encourage the patient to dress their weak side first
Rationale: Dressing the affected (weak) side first promotes independence and adaptive function by minimizing strain on the stronger side.
A nurse is caring for a patient with a left-sided stroke. Which expected symptom should be included in discharge teaching?
A. Impaired judgment and impulsivity
B. Difficulty with speech and language
C. Left-sided neglect
D. Short attention span and memory loss
Correct Answer: B. Difficulty with speech and language
Rationale: Left-hemispheric strokes typically cause aphasia (language impairment) and speech difficulties because the left hemisphere controls language processing.
A patient with a hemorrhagic stroke is receiving nimodipine. What is the primary reason for this medication?
A. Prevent seizures
B. Lower blood pressure rapidly
C. Reduce cerebral vasospasm
D. Promote clot formation
Correct Answer: C. Reduce cerebral vasospasm
Rationale: Nimodipine (a calcium channel blocker) is given after subarachnoid hemorrhage to prevent vasospasm, which can lead to secondary ischemic injury.
A patient recovering from a stroke is experiencing unilateral neglect. What should the nurse include in the care plan?
A. Approach the patient from the unaffected side
B. Place objects on the affected side to encourage use
C. Avoid placing stimuli on the affected side
D. Use a restraint to prevent injury from the neglected limb
Correct Answer: B. Place objects on the affected side to encourage use
Rationale: Patients with unilateral neglect ignore one side of their body. Placing objects on the affected side encourages awareness and engagement, promoting recovery
A nurse is teaching a patient with chronic hypertension about stroke prevention. Which statement indicates understanding?
A. “I should stop taking my blood pressure medication once I feel better.”
B. “I need to avoid all exercise to prevent blood pressure spikes.”
C. “I should reduce my salt intake and monitor my blood pressure regularly.”
D. “My risk of stroke is low as long as I don’t have symptoms.”
Correct Answer: C. “I should reduce my salt intake and monitor my blood pressure regularly.”
Rationale: Hypertension is the biggest modifiable risk factor for stroke. Patients should monitor BP, limit sodium intake, and continue medications as prescribed.
A patient with a history of stroke is prescribed aspirin and clopidogrel. What is the primary purpose of these medications?
A. Reduce blood pressure
B. Prevent platelet aggregation
C. Lower cholesterol levels
D. Dissolve existing clots
Correct Answer: B. Prevent platelet aggregation
Rationale: Aspirin and clopidogrel (Plavix) are antiplatelet agents that prevent platelet aggregation, reducing the risk of stroke recurrence. They do not dissolve existing clots.
A patient with an ischemic stroke has new-onset confusion and decreased responsiveness. What is the nurse’s priority action?
A. Assess blood glucose levels
B. Perform a swallowing assessment
C. Lower the head of the bed
D. Reorient the patient to time and place
Correct Answer: A. Assess blood glucose levels
Rationale: Hypoglycemia and hyperglycemia can mimic or worsen stroke symptoms. Checking blood glucose is a priority to rule out metabolic causes of confusion.
A nurse is planning discharge teaching for a stroke patient with dysphagia. Which instruction should be included?
A. “Eat quickly to reduce fatigue during meals.”
B. “Drink water with every bite of food to aid swallowing.”
C. “Sit upright at a 90-degree angle while eating.”
D. “Use a straw for drinking liquids to prevent aspiration.”
Correct Answer: C. “Sit upright at a 90-degree angle while eating.”
Rationale: Patients with dysphagia should eat in an upright position to prevent aspiration. Thin liquids and straws should be avoided as they increase aspiration risk.
A patient who had a stroke has residual left-sided weakness and is starting rehabilitation. Which goal should be prioritized?
A. Regaining full strength within two weeks
B. Preventing complications and maximizing function
C. Avoiding the use of assistive devices
D. Completing all tasks independently without help
Correct Answer: B. Preventing complications and maximizing function
Rationale: Stroke rehabilitation focuses on preventing complications (e.g., contractures, pressure injuries) and maximizing independence, even if full function is not regained.
A nurse is monitoring a patient taking warfarin after a stroke. Which finding requires immediate intervention?
A. INR of 2.5
B. Bruising on the arms
C. Sudden onset of confusion and headache
D. Mild gum bleeding when brushing teeth
Correct Answer: C. Sudden onset of confusion and headache
Rationale: Sudden confusion and headache may indicate intracranial bleeding, a serious complication of anticoagulant therapy. This requires immediate medical evaluation.
A nurse is providing education to a patient with a history of stroke about warning signs of a transient ischemic attack (TIA). Which statement by the patient indicates a need for further teaching?
A. “A TIA increases my risk of having a stroke.”
B. “My symptoms may resolve within an hour.”
C. “If my symptoms go away, I don’t need to go to the hospital.”
D. “I need to take my blood pressure medications as prescribed.”
Correct Answer: C. “If my symptoms go away, I don’t need to go to the hospital.”
Rationale: A TIA is a warning sign of a future stroke and requires immediate medical evaluation to prevent long-term damage. Ignoring symptoms can be life-threatening.
A nurse is caring for a patient with a stroke who has new-onset urinary incontinence. Which intervention is most appropriate?
A. Insert an indwelling catheter
B. Implement a scheduled toileting program
C. Restrict fluid intake
D. Encourage the patient to use adult diapers
Correct Answer: B. Implement a scheduled toileting program
Rationale: Bladder training through a scheduled toileting program helps patients regain bladder control. Indwelling catheters increase infection risk and should be avoided unless necessary.
A patient with a stroke is prescribed atorvastatin. The patient asks why they need this medication. What is the best response by the nurse?
A. “It helps prevent blood clots from forming.”
B. “It will lower your blood pressure.”
C. “It reduces cholesterol, which can help prevent another stroke.”
D. “It will dissolve any existing plaque in your arteries.”
Correct Answer: C. “It reduces cholesterol, which can help prevent another stroke.”
Rationale: Statins (e.g., atorvastatin) lower LDL cholesterol and reduce the risk of future strokes by preventing atherosclerosis progression.
A patient recovering from a stroke has difficulty swallowing. Which action should the nurse take first?
A. Start the patient on a soft mechanical diet
B. Perform a bedside swallowing assessment
C. Insert a nasogastric tube for feeding
D. Encourage the patient to drink thickened liquids
Correct Answer: B. Perform a bedside swallowing assessment
Rationale: A swallowing assessment should be performed first to determine the safest diet. Starting a diet without an assessment increases the risk of aspiration pneumonia.
A patient with a history of stroke reports sudden severe pain and redness in the left leg. What is the nurse’s priority action?
A. Assess the affected limb for warmth and pulses
B. Apply warm compresses to the affected leg
C. Elevate the leg and apply compression stockings
D. Encourage the patient to ambulate
Correct Answer: A. Assess the affected limb for warmth and pulses
Rationale: Sudden severe pain and redness could indicate deep vein thrombosis (DVT), a common complication after stroke. Assessing pulses and warmth helps determine perfusion and clot risk.
A patient who had a stroke is experiencing difficulty speaking but can understand language. This condition is known as:
A. Dysarthria
B. Broca’s aphasia
C. Wernicke’s aphasia
D. Global aphasia
Correct Answer: B. Broca’s aphasia
Rationale: Broca’s aphasia (expressive aphasia) affects speech production but preserves comprehension. Wernicke’s aphasia affects language comprehension.
A nurse is preparing a patient for a carotid endarterectomy. What is the purpose of this procedure?
A. Remove plaque from the carotid artery to restore blood flow
B. Place a stent in a coronary artery to prevent a heart attack
C. Remove a blood clot from the brain
D. Break down an embolism in the lungs
Correct Answer: A. Remove plaque from the carotid artery to restore blood flow
Rationale: A carotid endarterectomy removes plaque buildup in the carotid arteries to prevent future strokes by improving blood flow to the brain.
A nurse is educating a patient about post-stroke rehabilitation. Which statement indicates the patient understands the teaching?
A. “I will likely return to my normal activities within a week.”
B. “It is normal to feel depressed or frustrated during recovery.”
C. “I don’t need therapy since my symptoms have improved.”
D. “Once I recover, I won’t need to worry about another stroke.”
Correct Answer: B. “It is normal to feel depressed or frustrated during recovery.”
Rationale: Emotional changes like depression and frustration are common after a stroke. Ongoing rehabilitation is essential to maximize recovery and prevent complications.
A patient with a stroke is experiencing difficulty maintaining balance when walking. What is the most appropriate nursing intervention?
A. Encourage the patient to walk independently
B. Use a gait belt and assistive devices during ambulation
C. Advise the patient to avoid walking to prevent falls
D. Place restraints on the patient for safety
Correct Answer: B. Use a gait belt and assistive devices during ambulation
Rationale: Gait belts and assistive devices (e.g., walkers, canes) promote safe ambulation and prevent falls in stroke patients with balance difficulties.
A patient recovering from a stroke is being discharged home. Which caregiver instruction is most important?
A. “Encourage the patient to eat large meals to prevent weight loss.”
B. “Only allow the patient to perform activities independently.”
C. “Monitor for signs of depression and seek support if needed.”
D. “Avoid using mobility aids to promote faster recovery.”
Correct Answer: C. “Monitor for signs of depression and seek support if needed.”
Rationale: Depression is common after a stroke and can impact recovery and quality of life. Caregivers should monitor for mood changes and seek support if necessary.
. A patient is receiving alteplase (tPA) for an ischemic stroke. Which assessment finding requires immediate action?
A. Mild headache
B. Blood pressure of 160/90 mmHg
C. New onset of confusion and restlessness
D. Bruising at the IV insertion site
Correct Answer: C. New onset of confusion and restlessness
Rationale: New confusion and restlessness could indicate intracranial bleeding, a serious complication of tPA therapy. This requires immediate medical attention.
A nurse is assessing a patient with increased intracranial pressure (ICP). Which finding indicates worsening ICP?
A. Increasing drowsiness and sluggish pupil reactions
B. Blood pressure of 120/80 mmHg
C. Glasgow Coma Scale (GCS) score of 15
D. Equal and reactive pupils
Correct Answer: A. Increasing drowsiness and sluggish pupil reactions
Rationale: Worsening ICP causes decreased level of consciousness (LOC), sluggish pupil reactions, and Cushing’s triad (hypertension, bradycardia, and irregular respirations).
A nurse is caring for a patient who had an ischemic stroke and is receiving IV alteplase (tPA). Which assessment finding is most concerning?
A. Mild headache and nausea
B. Systolic blood pressure of 180 mmHg
C. Bruising around the IV insertion site
D. Facial droop and right-sided weakness
Correct Answer: B. Systolic blood pressure of 180 mmHg
Rationale: Hypertension increases the risk of intracranial bleeding in patients receiving tPA. BP must be controlled (below 180/105 mmHg) to prevent hemorrhagic transformation.
A patient who had a stroke is prescribed clopidogrel (Plavix). What instruction should the nurse include?
A. “Take this medication with food to prevent nausea.”
B. “You may experience occasional bruising and gum bleeding.”
C. “This medication will dissolve any existing blood clots.”
D. “Stop taking this medication if you feel dizzy or weak.”
Correct Answer: B. “You may experience occasional bruising and gum bleeding.”
Rationale: Clopidogrel is an antiplatelet medication that reduces clot formation but does not dissolve existing clots. Minor bruising and gum bleeding are expected but should be monitored for excessive bleeding.
A nurse is preparing to discharge a patient who had a stroke and is at risk for falls. Which statement by the caregiver indicates appropriate home modifications?
A. “I will place rugs in the hallways to prevent slipping.”
B. “We will install grab bars in the bathroom and remove clutter.”
C. “I will keep the house dimly lit at night to help them sleep.”
D. “I’ll encourage them to move around without assistance to build strength.”
Correct Answer: B. “We will install grab bars in the bathroom and remove clutter.”
Rationale: Grab bars and clutter-free environments reduce fall risk in stroke patients with balance issues, unilateral weakness, or visual impairments.
A patient with a history of stroke is being educated about secondary stroke prevention. Which statement by the patient requires further teaching?
A. “I should monitor my blood pressure regularly.”
B. “I need to quit smoking to lower my stroke risk.”
C. “I should stop taking my aspirin if I feel fine.”
D. “I will follow a heart-healthy diet and exercise regularly.”
Correct Answer: C. “I should stop taking my aspirin if I feel fine.”
Rationale: Aspirin is essential for stroke prevention and should not be stopped without consulting a healthcare provider. Stroke risk remains even if the patient feels fine.
