Self-Assessment Questions

This section provides a review. Mark each statement on the Answer Sheet according to the factual materials contained in this issue and the opinions of the authors.

Article One (pp. 151–161)

1. Type 1 clinical reasoning is also referred to as:

   • Detail-oriented, explicit clinical reasoning.

   • Intuitive, implicit clinical reasoning.

   • Computer-assisted reasoning.

   • Not applied in clinical environments.

   • Developmental clinical reasoning.

2. Type 2 clinical reasoning is also referred to as:

   • Computer-assisted reasoning.

   • Developmental clinical reasoning.

   • Intuitive, implicit clinical reasoning.

   • Not applied in clinical environments.

   • Detail-oriented, explicit clinical reasoning.

3. Case-based learning has got the following advantages:

   • Scaffolded learning environment.

   • Gradually increasing cognitive load.

   • Peer-assisted learning.

   • Authentic clinical learning opportunities in the classroom.

   • All of the above.

   Article Two (pp. 162–169)

4. An individual's competence, or legal capacity, is determined by:

   • A court of law.

   • A police officer.

   • A physician.

   • A surrogate decision-maker.

   • The patient himself.

5. Which of the following are acknowledged as key functional abilities for making a clinical decision?

   • Ability to express a choice.

   • Ability to understand the relevant information.

   • Ability to appreciate the situation as unique applies to oneself.

   • Ability to reason through the options and consequences.

   • All of the above.

6. Decision-making capacity reflects a particular decision to be made:

   • At that distinct moment in time.

   • For the duration of 1 week.

   • For the duration of the illness.

   • For the remainder of one's life.

7. The informed consent process must disclose:

   • Material facts.

   • Provider disclosure.

   • Personnel to be involved in the patient's care.

   • Additional procedures that may be required.

   • All of the above.

   Article Three (pp. 170–187)

8. In infants born prematurely, all of the following can indicate an increased risk of late oral feeding excep t:

   • Gestational age.

   • Sex of the infant.

   • Birthweight.

   • Lung disease.

   • Necrotizing enterocolitis.

9. Which of the following is an unacceptable reason for endotracheal intubation?

   • Maintain an open airway.

   • Maintain ventilation.

   • Rest the patient's respiratory system.

   • Maintain a proper level of oxygenation.

   • Protect the airway from aspiration.

10. Why is it important to identify tracheostomy tube characteristics such as the manufacturer, style, and size?

    • The angle of the tracheostomy tube varies.

    • The length of the tracheostomy tube varies.

    • The cuff shape varies.

    • Inflation materials change between tracheostomy tubes.

    • All of the above vary between manufacturer, style, and size of the tracheostomy tube.

11. Which of the following statements is true about tracheostomy tubes?

    • Cuff deflation must be continuous before evaluation and treatment can begin.

    • There are no current validated criteria for cuff deflation.

    • A patient breathing at a respiratory rate of 30 breaths per minute must be deferred until a reduced breathing rate is established.

    • Patients with oxygen saturations of 90% SpC>2 have greater risk for aspiration.

    • A speech-language pathologist is capable of determining medical stability, enough for a swallow screening and/or evaluation.

12. Which of the following statements about fiberoptic endoscopic evaluation of swallowing (FEES) is true when considering the advantages of its use in the ICU setting?

    • FEES is contraindicated in pediatric populations.

    • Breastfeeding mothers are not permitted to hold the infant during FEES.

    • Positioning/seating is no different than during the videofluoroscopic swallow study.

    • FEES cannot be performed in the patient's room because of the number of IV pumps, the ventilator, and other equipment.

    • Secretion management, spontaneous swallows, and very small volume oral trials may be assessed.

    Article Four (pp. 188–202)

13. Following a positive “failed” swallowing screening for acute stroke, the patient should be:

    • Made NPO until speech-language pathology evaluation.

    • Rescreened every nursing shift until the screening is negative

      passed.

    • Made NPO except for medication.

    • Started on a thickened liquid diet pending speech-language pathology consultation.

    • Made NPO and rescreened every nursing shift until the screening is negative “passed.”

14. Why is it important to assess compensatory swallowing strategies under instrumental assessment prior to prescribing them to a patient with dysphagia?

    • The patient may not want to follow a compensatory strategy unless it is evaluated with instrumental assessment.

    • It is important to evaluate compensatory swallowing strategies with instrumental assessment to determine if they improve safety or efficiency of intake, and if any negative effects occur with implementation.

    • This is done to determine the number of compensatory strategies that are effective.

    • It is important to assess compensatory swallowing strategies with instrumental assessments to determine if it is appropriate to bill for dysphagia therapy.

    • You should evaluate compensatory swallowing strategies under instrumental assessment only if the patient presents with continued signs of dysphagia after implementing them following the clinical swallowing examination.

15. In both the clinical swallowing examination and instrumental assessment, why is it recommended that the speech-language pathologist begin with administration of small volumes of thin liquids, prior to administration of thicker consistencies?

    • It is important to administer small liquid volumes first so that the patient can get accustomed to the assessment.

    • Starting with smaller volumes of thin liquids helps “warm-up” the muscles so that the patient is less likely to aspirate with larger volumes of liquids.

    • Thin liquids are less likely to result in residue which can affect subsequent swallows, and starting with small volumes can reduce the amount of liquid aspirated.

    • It is only recommended to start with larger volumes of thicker consistencies.

    • Small liquid volumes are less likely to be aspirated compared to small volumes of thicker consistencies.

16. What three rehabilitation exercises have been studied with disordered populations and have reported positive long-term biomechanical and clinical effects?

    • Mendelsohn maneuver, Shaker exercise, lingual resistance exercises.

    • Shaker exercise, lingual resistance exercises, expiratory muscle strength training.

    • Super-supraglottic swallow, effortful swallow, Masako maneuver.

    • Chin tuck against resistance exercise, lingual resistance training, and thermal-tactile application.

    • Expiratory muscle strength training, recline exercise, Mendelsohn maneuver.

17. A patient with an acute right hemispheric stroke and cognitive deficits including severely impaired attention, memory, and impulsivity demonstrates consistent thin liquid silent aspiration before the swallow during a videofluoroscopic swallowing study. Why it may be best to move directly into testing nectar-thick liquids rather than testing other compensatory swallowing strategies?

    • The patient does not like to drink thin liquids.

    • The patient does not like to use the other compensatory swallowing strategies.

    • Nectar-thick liquids always protect against aspiration.

    • Nectar-thick liquids do not require the cognitive demand and supervision that most other compensatory strategies do.

    • Chin tuck requires no more memory requirement than nectar thick liquids and should really be considered before thickened liquids.

    Article Five (pp. 203–212)

18. The conversation about nonoral feeding should be initiated:

    • Cnly when the patients are unable to swallow by mouth.

    • Early in the disease process to allow patients and caregivers to make informed decision about whether they want a feeding tube.

    • When respiratory status declines.

    • Never.

19. Management of dysphagia in neurologic disease may include:

    • Exercises.

    • Diet modification.

    • Compensatory maneuvers or postures.

    • All of these.

20. The course of the disease will impact:

    • Frequency of swallow evaluation/ reevaluation.

    • Nothing. It does not matter with regard to swallow evaluation and management.

    • The management goals (i.e., maintaining vs. improving function).

    • Both A and C.

    Article Six (pp. 213–226)

21. Which of the following does a speech-language pathologist provide within head and neck cancer patient management:

    • Intervention.

    • Rehabilitation.

    • Prehabilitation.

    • Risk-stratification

    • All of the above.

22. Late RAD refers to:

    • A progressive dysphagia associated with prior radiation therapy caused by fibrosis and degenerative cranial nerve.

    • A prophylactic exercise regimen used to protect pharyngeal musculature during radiotherapy.

    • An effect from radiotherapy identifiable within a week following treatment cessation.

    • A protective factor associated with chemoradiotherapy.

    • All of the above.

23. A speech-language pathologist would most likely utilize which of the following as part of their risk-stratification approach:

    • Patient- and clinician-reported outcome measures (e.g., FOIS or MDADI).

    • Swallowing evaluation with imagine (i.e., FEES or MBSS).

    • Evidence-based clinical assessment tools (e.g., MASA-C or IOPI).

    • Patient history and interview.

    • All of the above.

24. Patients with head and neck cancer-related dysphagia differ from other dysphagia populations because:

    • They are unable to make informed choices.

    • They are often neurotypical and able to engage in shared decision making.

    • They exhibit an inability to be an active participant in their rehabilitation.

    • They exhibit self-resolving dysphagia without any need for intervention.

    • All of the above.

25. A critical role in the management of the surgically managed head and neck cancer patient is:

    • Pretreatment education and counseling about expected functional changes with respect to swallowing.

    • Pretreatment baseline evaluation of swallowing function based on clinical risk stratification.

    • Investigation of swallowing strategy utility.

    • Prescription of range of motion and strengthening exercises.

    • All of the above.

    Article Seven (pp. 227–242)

26. Select the change(s) to swallow physiology that is expected with age.

    • Increased swallow apnea.

    • Increased pressures exerted in the oral cavity.

    • Increased pressures exerted in the pharynx.

    • B and C only.

    • All of the above.

27. Spouses and children of older adults with dysphagia both suffer from:

    • Emotional burden.

    • Physical burden.

    • Financial burden.

    • A and B.

    • B and C.

28. Dehydration in older adults may lead to:

    • Delirium.

    • Xerostomia.

    • Infections.

    • Hypotension.

    • All of the above.

29. Ethnographic approach includes listening to the behaviors and beliefs of:

    • The patient only.

    • The caregiver only.

    • The patient and/or caregiver.

    • Other healthcare professionals.

    • The assessing clinician

30. Management of dysphagia in older adults should:

    • Be individualized.

    • Consider the physiological deficits.

    • Be implemented only for outpatients.

    • Only include compensatory techniques.

    • A and B.