Evaluation and Treatment of Apraxia in Children: Speech-Language Pathology, Exams of Nursing

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SLP ETS Practice Test Form 1 (2024)

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Which of the following should be the primary focus of early language intervention for at-risk infants? A.Establishing object permanence through play activities B.Training primary caregivers to facilitate language learning C.Creating readiness activities in the context of play D.Enhancing social communication through play activities Answer- Option (B) is correct. Early language stimulation in at-risk infants is best provided by primary caregivers who have been trained in practices that promote learning. The figure above shows the oral, pharyngeal, and esophageal structures involved in swallowing. Which of the following best describes the transit of the bolus at the moment depicted in the figure? A.The bolus is traveling through the esophagus. B.The bolus is being propelled from the oral cavity by the tongue and has entered the pharynx. C.The bolus has passively exited the oral cavity without propulsion by the tongue. D.Laryngeal penetration of some of the bolus is evident. Answer- Option (B) is correct. The tongue is in contact with the entire anterior and most of the mid to posterior hard palate. Furthermore, the bolus head has passed the epiglottis and is descending into the hypopharynx. Primary motor innervation to the larynx and velum is provided by which cranial nerve? A.V B.VII C.IX D. X Answer- Option (D) is correct. Primary innervation to the larynx and velum is provided by cranial nerve X, the vagus nerve. The other answer choices identify cranial nerves that are not primarily involved in motor innervation to the larynx and velum. GOT WRONG Fela is a third-grade student in a public school. She is a speaker of African American Vernacular English (AAVE) who has difficulty with the Standard American English

(SAE) dialect used in her classroom. Her teacher believes that Fela's language skills are affecting her academic performance and has referred her to the school's speech- language pathologist. Which of the following is an appropriate rationale for providing language intervention for Fela? Select all that apply. A.It will likely foster better communication with Fela's linguistically and culturally diverse peers. B.It will likely improve Fela's code-switching ability with her teacher and other adult speakers of SAE. C.It may expand Fela's later academic and vocational opportunities. D.It will likely lead Fela to adopt SAE as her primary dialect. Answer- Options (A), (B), and (C) are correct. The intervention will foster better communication because Fela and her peers will have a common dialect. Also, the intervention will provide Fela with the ability to switch easily between dialects using SAE structures. Furthermore, being able to switch codes will enable Fela to participate in more educational and vocational opportunities. Federal laws regarding freedom of access to information stipulate that client records kept or written by health care professionals can be A.reviewed only by other health-care professionals B.reviewed only by the clients themselves unless the client provides written permission to share with others C.reviewed by anyone who submits a formal written request D.released only by subpoena Answer- Option (B) is correct. Clients have the right to review their own records. To justify providing individual treatment for a 2½ year old with apraxia of speech, which of the following would be LEAST important for the SLP to include in the evaluation report? A.A description of the child's typical interaction with peers B.Relevant prognostic data C.Information about apraxia of speech D.A description of the language development of the child's older siblings Answer- Option (D) is correct. A description of the child's older siblings' language development does not provide the objective, documented evidence required to justify provision of treatment for a child of an age at which some unintelligibility would be typical. The speech reception threshold (SRT) is a basic component of an evaluation of hearing function. Which of the following statements about the SRT is most accurate? A.It is measured in decibels and corresponds to the intensity level at which spondaic words can be recognized approximately 50% of the time. B.It makes use of test materials that are limited to monosyllabic words. C.It provides information on how well speech is understood at conversational levels.

D.It is useful in validating acoustic intermittence measures. Answer- Option (A) is correct. It is an accurate definition of the speech reception threshold. A clinician who employs active listening is doing which of the following? A.Responding to both the content and the affect of the client's remarks B.Listening very carefully and taking extensive notes C.Conducting a clinician-directed interview D.Directing the client to specific answers to questions Answer- Option (A) is correct. A clinician who employs active listening responds to both the content (the denotative message) and the affect (the emotional content) of a client's remarks. This investigation was motivated by observations that when persons with dysarthria increase loudness, their speech improves. Some studies have indicated that this improvement may be related to an increase of prosodic variation. Studies have reported an increase of fundamental frequency (F0) variation with increased loudness, but there has been no examination of the relation of loudness manipulation to specific prosodic variables that are known to aid a listener in parsing out meaningful information. This study examined the relation of vocal loudness production to selected acoustic variables known to inform listeners of phrase and sentence boundaries: specifically, F0 declination and final-word lengthening. Ten young, healthy women were audio-recorded while they read aloud a paragraph at what each considered normal loudness, twice-normal loudness, and half-normal loudness. Results showed that there was a statistically Answer- Option (C) is correct. The researchers manipulated vocal loudness to determine its effect on prosodic F0 and durational variables. This investigation was motivated by observations that when persons with dysarthria increase loudness, their speech improves. Some studies have indicated that this improvement may be related to an increase of prosodic variation. Studies have reported an increase of fundamental frequency (F0) variation with increased loudness, but there has been no examination of the relation of loudness manipulation to specific prosodic variables that are known to aid a listener in parsing out meaningful information. This study examined the relation of vocal loudness production to selected acoustic variables known to inform listeners of phrase and sentence boundaries: specifically, F0 declination and final-word lengthening. Ten young, healthy women were audio-recorded while they read aloud a paragraph at what each considered normal loudness, twice-normal loudness, and half-normal loudness. Results showed that there was a statistically Answer- Option (B) is correct. At the end of the abstract, the researchers Hughes suggest a relationship between increased vocal loudness and "improvement in communicative effectiveness" in some persons with dysarthria. This relationship is not directly supported by their study, as individuals with dysarthria were not tested. This investigation was motivated by observations that when persons with dysarthria increase loudness, their speech improves. Some studies have indicated that this improvement may be related to an increase of prosodic variation. Studies have reported an increase of fundamental frequency (F0) variation with increased loudness, but there has been no examination of the relation of loudness manipulation to specific prosodic variables that are known to aid a listener in parsing

out meaningful information. This study examined the relation of vocal loudness production to selected acoustic variables known to inform listeners of phrase and sentence boundaries: specifically, F0 declination and final-word lengthening. Ten young, healthy women were audio-recorded while they read aloud a paragraph at what each considered normal loudness, twice-normal loudness, and half-normal loudness. Results showed that there was a statistically Answer- Option (C) is correct. The researchers use the same group of subjects who recite a paragraph under three conditions: at normal, twice-normal, and half-normal loudness. This is an example of a within-subjects design, in which the dependent variables (in this case, prosodic F0 and durational variables) are measured repeatedly in the same subjects under different task conditions (in this case, vocal loudness). A 55-year-old woman, recently hospitalized for probable cerebrovascular accident (CVA), is referred for evaluation of stuttering speech. The initial conversation with the client indicates that speech is characterized by frequent initial-phoneme repetitions and prolongations as well as associated mildly effortful eye blinking. Which of the following pieces of information is crucial to accurate speech diagnosis and decisions regarding management of the speech problem? A.The site and extent of the lesion associated with the suspected CVA B.Whether the client has any associated dysphagia or dysphonia C.Whether the dysfluencies began before or after the suspected CVA D.Whether the client feels frustrated by the dysfluencies Answer- Option (C) is correct. Dysfluent speech may or may not be directly caused by the patient's suspected CVA. GOT WRONG Which of the following is the best action to take initially with a client who presents with poor oral control of liquids and solids, coughing and choking while eating and drinking, and a history of hospitalizations associated with pneumonia? A.Thickening liquids so that the client will be better able to control oral movements for swallowing B.Obtaining a modified barium-swallow study to determine appropriate interventions C.Evaluating the client's ability to eat a variety of foods in order to determine which foods are safest D.Prescribing that the client be NPO, since aspiration is present Answer- Option (B) is correct. An assessment of the problem must be undertaken before treatment is provided, and the best way to do this is to obtain a modified barium-swallow study. A number of research reports have described poor auditory memory in children with language impairments. Which of the following can most appropriately be concluded from these studies? A.Poor auditory memory can be improved by language-intervention programs that focus on teaching vocabulary and word meanings. B.Poor auditory memory is a reflection of a language impairment, and clinicians and researchers cannot effect improvement.

C.Poor auditory memory could be a reflection or a cause of a language impairment or could be related to some other factor, and further research is needed to determine which is the case. D.Children with language impairments normally do not have well-developed representational skills. Answer- Option (C) is correct. Research reports are restricted to the variables examined in the studies on which they are based. A relationship between poor auditory memory and language impairment has been found in some research studies. Other factors could be involved, however, suggesting that further research is needed. Conclusions about treatment or the effects of the impairment must be made through additional research studies. GOT WRONG 2ND TIME Ms. Brown, a 70-year-old retired female, was admitted to the hospital following a CVA. The SLP conducted a comprehensive evaluation that revealed the presence of left-side neglect, anosognosia (denial of impairment), and visuospatial problems, including prosopagnosia (difficulty recognizing familiar faces). Although her auditory comprehension and repetition skills were good, she experienced difficulty with topic maintenance and turn taking. Based on the clinical features described, Ms. Brown's diagnostic classification would most likely be A.Wernicke's aphasia B.Conduction aphasia C.Cognitive-communicative disorder consistent with right hemisphere damage D.Cognitive-communicative disorder consistent with left hemisphere damage Answer- Option (C) is correct. The symptoms described in the scenario are consistent with damage to the right hemisphere. GOT WRONG A client exhibits weakness, atrophy, and fasciculations of the right side of the tongue and lower face. The client also has right vocal-fold weakness and nasal regurgitation of fluid when swallowing. These problems are the result of damage to which part of the nervous system? A.Brain stem B.Cerebellum C.Left cerebral cortex D.Right cerebral cortex Answer- Option (A) is correct. Weakness, atrophy, fasciculations, and the other described symptoms are all consistent with a lower motor neuron locus and suspected cranial nerve abnormalities (primarily CN X and XII). These cranial nerves emerge directly from the brain stem and help mediate the transfer of messages from the brain to the brain stem and to the structures of the head and neck. GOT WRONG Which of the following constitutes the major component of an audiologic rehabilitation program for infants with a moderate sensorineural hearing loss?

A.Development of cognitive skills B.Development of social skills C.Parent-mediated auditory stimulation D.Gestural stimulation Answer- Option (C) is correct. For an infant known to have a hearing loss, parents are in the best position to provide consistent auditory stimulation, which the infant needs in order to develop an awareness of sound. GOT WRONG 2ND TIME A child exhibits the following production errors. w/r θ/s t/ʃ t/tʃ z/dʒ t/k d/g If a target sound for initial intervention is to be selected on the basis of established developmental norms, then that sound will be A./s/ B./ʃ/ C./k/ D./tʃ/ Answer- Option (C) is correct. According to developmental norms, /k/ is the target phoneme that should be selected for intervention. GOT WRONG A public-school-based speech-language pathologist is employed in a state that sets the maximum caseload at 65. However, the clinician's caseload is currently at 64 with a waiting list of 10 additional students. The school principal insists that the speech-language pathologist enroll the 10 students immediately, because the district cannot locate another clinician to assist with the caseload. Which of the following is the most appropriate way for the speech-language pathologist to address the situation? A.Enroll 1 of the 10 students and provide the principal with a written statement of caseload needs, mentioning the amount, type, and frequency of treatment B.Refer the 10 students to a speech-language pathologist working in a private setting C.Suggest that the principal ask a school speech-language pathologist from another school district to take the 10 students D.Maintain current caseload until an additional speech-l Answer- Option (A) is correct. It provides the principal with a statement detailing the needs of the students awaiting treatment but also observes the state's caseload limit. Fiber-optic instrumentation is appropriate for evaluation of which of the following types of disorders?

A.Articulation B.Phonation C.Proprioception D.Respiration Answer- Option (B) is correct. Fiber-optic nasopharyngoscopy or laryngoscopy is a commonly used approach to evaluate vocal fold anatomy and physiology for voice production (phonation). GOT WRONG Which of the following views make up a standard videofluoroscopic swallow study? Select all that apply. A.Frontal B.Lateral C.Transverse D.Anterior-posterior Answer- Options (B) and (D) are correct. A lateral view is best for seeing all stages of a swallow, and an anterior-posterior view shows the symmetry (or asymmetry) of the swallow. Hearing loss in infants who are born with a cleft palate is usually related to which of the following? A.The infant's inability to create positive pressure in the oral cavity B.Malformation of the middle-ear ossicles associated with malformation of the palate C.Eustachian tube dysfunction D.Cochlear dysfunction Answer- Option (C) is correct. Eustachian tube dysfunction, a major factor contributing to middle-ear disease and conductive hearing loss, is nearly universal in infants with cleft palate. GOT WRONG Which of the following, if observed in the speech of an African American child, is most likely to represent a dialectical variation rather than an articulation error? A./f/ for /θ/ in postvocalic position B./θ/ for /s/ in all positions C.Affricates for fricatives in word-final position D.Dentals for velars in word-initial position Answer- Option (A) is correct. The use of voiceless labiodental fricatives for voiceless interdental fricatives is a feature of African American Vernacular English (AAVE). Children diagnosed as having specific language impairments are likely to exhibit the greatest deficits in which of the following? A.Production of sentences with appropriate inflectional morphology and syntax B.Acquisition of word meanings C.Comprehension of short sentences

D.Motoric aspects of written expression Answer- Option (A) is correct. Children with specific language impairments typically have difficulty producing utterances that are morphologically and syntactically well formed. GOT WRONG A 5-year-old girl with a repaired cleft palate has recently undergone a pharyngeal flap operation to correct velopharyngeal incompetence, but she continues to use glottal stops, pharyngeal fricatives, and mid-dorsum palatal stops. Which of the following is the most appropriate action for the SLP to take? A.Recommending that the child be examined by a cleft palate team to determine the cause of the persistent articular errors B.Referring the child back to the surgeon to determine the need for a revision of the pharyngeal flap C.Initiating articulation treatment to teach the correct placement for the stops and fricatives D.Initiating articulation treatment to teach correct production of nonpressure consonant sounds Answer- Option (C) is correct. This child is using compensatory glottal stops, mid-dorsum palatal stops, and pharyngeal fricatives for standard American English stops and fricatives. She has had surgical management to correct velopharyngeal incompetence. She now needs to learn to produce the stops and fricatives for which she is making compensations. Therefore, articulation treatment is appropriate. GOT WRONG The major objective of auditory training in the treatment of a client with a hearing loss is to A.improve the client's awareness of position and movements of the speech mechanism B.improve the client's kinesthetic and auditory awareness C.increase the client's kinesthetic and proprioceptive discrimination D.teach the client to make discriminations among speech sounds Answer- Option (D) is correct. Auditory training focuses on the interpretation of auditory input and would thus teach a client to discriminate speech sounds. GOT WRONG A 70-year-old female has dysphagia characterized by poor posterior oral containment of the bolus during the oral preparatory stage, causing aspiration before the swallow. Cognition and the pharyngeal stage of the swallow are intact. Which of the following is the most appropriate treatment approach for the client? A.Providing a puree diet with thickened liquids B.Having the client flex her head forward (perform the chin-down posture) during oral preparation and transit stages of the swallow C.Having the client turn (rotate) her head to the right when swallowing

D.Providing a diet that consists of thin liquids Answer- Option (B) is correct. This treatment alters oral configuration to place the base of the tongue superior to the bolus inside the oral cavity. Since liquid cannot flow uphill against gravity, this intervention compensates for impaired palatoglossus contraction, which is causing impaired posterior oral containment. An SLP receives a referral regarding a 4-year-old boy who uses two words spontaneously and functionally, who began walking at 3 years of age, and who responds to his name inconsistently. On the basis of the information alone, the SLP can legitimately conclude that the child's communication profile reflects A.a developmental delay B.autism spectrum disorder C.a chromosomal anomaly D.a metabolic disorder Answer- Option (A) is correct. A 4-year-old typically developing child would have 4 word utterances and would respond to his name consistently. Most children start to walk around age 1. Therefore, the delay in walking, along with the delay in language, indicates a general developmental delay. Successful use of an alternative and augmentative communication system is based on such factors as selecting appropriate vocabulary, seating and positioning, and having a reliable method of controlling the system. To facilitate the most effective use of the system, clinicians most often advocate which of the following approaches? A.Unimodal B.Multimodal C.Bimodal D.Gestural Answer- Option (B) is correct. A multimodal approach offers more communicative options than any other of the approaches listed. Which of the following is most important for an SLP to do when assessing a child who has an acquired brain injury? A.Evaluate pragmatics through a structured language test B.Compare premorbid performance with present performance C.Ensure administration of an intelligence test D.Compare nonverbal performance with verbal performance Answer- Option (B) is correct. An SLP needs to know what skills the child attained prior to the brain injury in order to select appropriate treatment goals. GOT WRONG Which of the following is the most important acoustic cue that distinguishes between an unreleased final /p/ and an unreleased final /b/, as in "cap" versus "cab"? A.Locus frequency of burst B.Voice onset time C.Vocal fundamental frequency D.Duration of the preceding vowel Answer- Option (D) is correct. Research shows that vowel duration influences a listener's perception of voicing. Vowels that precede

unreleased voiced stop consonants are as much as 1.5 times as long as vowels that precede voiceless stops. GOT WRONG 2ND TIME When counseling the parents of a child who has an articulation disorder, the SLP can cite developmental norms to show which of the following? A.The child's misarticulation will interfere with reading skills. B.A certain percentage of children of a certain age can correctly articulate the misarticulated sound. C.The misarticulation is caused by faulty learning. D.The misarticulation is not physically based. Answer- Option (B) is correct. Developmental norms demonstrate that a certain percentage of children of a given age can correctly articulate certain sounds. Language intervention for a child at the one-word stage should be most strongly influenced by a consideration of the child's A.motor skills B.cognitive skills C.syntactic skills D.articulation skills Answer- Option (B) is correct. The cognitive skills of a child at the one-word stage will most strongly influence the child's speech-language responses, so language intervention for the child should take into account the child's cognitive skills. A single exposure of several hours duration to continuous music with an overall level of 100 dB SPL will most likely produce A.tinnitus and a temporary threshold shift in high frequencies B.tinnitus and a distortion of speech perception C.a temporary threshold shift in the low frequencies D.a permanent threshold shift Answer- Option (A) is correct. A single exposure of several hours duration to continuous music at a level of about 100 dB SPL will most likely produce tinnitus and a temporary threshold shift in the high frequencies. GOT WRONG According to research on the development of Brown's morphemes in young children, which of the following is a determinant of acquisition order? A.Phonological ease of production B.Figurative-language ability C.Semantic and syntactic complexity D.Sequencing and segmentation strategies Answer- Option (C) is correct. Brown's morphemes are acquired by children in an order that is determined by semantic and syntactic complexity, with the simplest forms acquired first. The order of acquisition is typically followed by all children.

GOT WRONG

John is a 4 1/2 year old whose consonantal inventory includes word-initial [ w ], [ m ], [ n ], [ p ], [ b ], [ t ], [ d ], and [ f ]. He uses [ t ] for /k/, [ d ] for /ɡ/, [ b ] for /v/, and [ f ] for /θ/. He produces no consonant clusters. His word-final consonantal inventory consists of [m] and [n]. His word shape inventory includes V, CV, CVC, and CVCV. The information given most strongly indicates that the child has A.childhood apraxia of speech B.an oral motor impairment C.delayed phonological development D.a significant high-frequency hearing loss Answer- Option (C) is correct. The pattern describes the phonological pattern of a younger child. The errors are consistent, unlike childhood apraxia of speech, which has an inconsistent error pattern. Children at this age typically have mastered consonant clusters and use word-final consonants. After sustaining a CVA, Ms. Williams, age 75, was referred to an SLP for a speech and language evaluation. While Ms. Williams was describing the cookie-theft picture, the SLP observed that her grammatical structure appeared to be intact and her prosody was normal but that many of her sentences were meaningless, did not fit the context, and included nonsensical paraphasic errors. Additional testing also revealed that Ms. Williams exhibited poor repetition and naming skills, did not respond appropriately to many simple commands, and had difficulty reading. Ms. Williams appeared happy and talked excessively. She did not appear to be aware of her communication deficits. What is the most likely location of the lesion? A.Left posterior superior temporal gyrus B.Left inferior frontal gyrus C.Left superior frontal gyrus D.Left inferior parietal gyrus Answer- Option (A) is correct. The symptoms that are described in the scenario are consistent with damage to the left posterior superior temporal gyrus. GOT WRONG Before an SLP initiates voice intervention, it is most important that the SLP gather information about the A.cause of the client's voice problem B.client's breathing patterns C.client's oral motor skills D.fundamental frequency of the client's laryngeal tone Answer- Option (A) is correct. It is essential to know the cause of a voice problem prior to commencing voice intervention, because some voice problems are symptoms of diseases/disorders (e.g., laryngeal cancer) that do not respond to the types of voice interventions that an SLP typically provides, and can only be treated through medical intervention.

Excessive nasality is associated with inadequate velopharyngeal closure. An SLP is training a client to self-monitor nasality during speech. Which of the following tactics will best allow the speaker to determine whether there is excessive nasal airflow? A.Looking in a mirror while speaking B.Being aware of vowel-sound productions C.Speaking/phonating while alternately leaving the nostrils open and pinching them closed D.Monitoring production of consonant blends Answer- Option (C) is correct. Speaking while alternately leaving the nostrils open and pinching them closed is an easy way for a speaker to determine whether inappropriate nasal airflow is occurring. This technique allows one to determine the difference in airflow pattern when speech is produced with the nostrils occluded as compared with speech produced when the nostrils are open. For a speaker with velopharyngeal incompetence, closure of the nostrils will eliminate the nasal airflow in production of /s/. Which of the following best describes the rationale for using standardized, norm- referenced instruments to assess speech-language functioning? A.They enable the clinician to generate weekly statements about a client's treatment progress. B.They provide the clinician with the information that is necessary to generate a specific and comprehensive treatment plan. C.They enable the clinician to understand and make informed statements about how a client's performance compares with the performance of other people. D.They provide the clinician with reliable information about how well a client is likely to respond to treatment. Answer- Option (C) is correct. The use of standardized normative instruments enables a clinician to compare a client's language and speech function with the average normal function for a person in the client's age range. An SLP who is treating an adolescent who stutters designs a treatment plan that includes three fluency management strategies: prolonged speech, cancellation, and pullout. Which of the following is true about the use of these treatment strategies? Select all that apply. A.Use of prolonged speech is likely to reduce the frequency of part-word repetitions and sound prolongations significantly. B.Each of the three strategies entails deliberate regulation of speech motor movements. C.The client will seek to apply cancellation whenever he feels anxious about the possibility of stuttering overtly. D.The client will seek to apply pullout during the course of part-word repetition or sound prolongation. Answer- Options (A), (B), and (D) are correct. Prolonged speech, deliberate regulation of speech motor movements, and pullout could all be appropriately applied. GOT WRONG

A client with anomic aphasia is a native speaker of Spanish with fair proficiency in English. Production of the word "shoes" as [tʃuz] on a repetition task is most likely due to which of the following factors? A.Phonological interference from the speaker's native language B.Semantic interference from the speaker's native language C.Semantic paraphasia due to the aphasia D.Phonemic paraphasia due to the aphasia Answer- Option (A) is correct. The Spanish language does not have /f/ in its phonemic inventory, and native speakers of Spanish typically substitute the affricate /t∫/ / t ∫ / when producing English words with that phoneme. A native speaker of Spanish would most likely have made the substitution before acquiring an anomic aphasia. An SLP has a consultation with a self-referred adult who has a fluency disorder. The client had been enrolled in treatment programs with the clinician three times before and had reached from 75 to 90 percent fluency before dropping out of treatment for various reasons. Thirty percent of the client's syllables are spoken disfluently. The client also exhibits signs of depression and anxiety. Which of the following is the most appropriate action for the SLP to take? A.Encouraging the client to re-enroll for remedial services B.Encouraging the client to take responsibility for maintaining fluency by using techniques learned in the previous treatment sessions C.Recommending that the client schedule a neurological evaluation D.Referring the client for psychological counseling Answer- Option (D) is correct. Psychological counseling is most appropriate for a client who appears interested in improving speech but has not remained motivated long enough to complete the several treatment programs started. The client also does not exhibit maintenance of benefits from prior treatment. Thus, psychological counseling should precede any further remedial efforts. Immediately following removal of a benign tumor from the base of the brain, a 76- year-old client exhibits severe nasalization and a weak, breathy voice. A four-month postsurgical assessment reveals no improvement. At this time, the remediation strategy for this client should focus on A.evaluation for prosthetic or surgical intervention B.strengthening exercises for the oral articulators C.a trial period using the yawn-sign technique D.complete vocal rest Answer- Option (A) is correct. The client has a resonance and phonation disorder indicative of velopharyngeal and laryngeal problems. The velopharyngeal problem could be assisted by prosthetic or surgical intervention. GOT WRONG

A 12-year-old native speaker of Spanish who has been studying English as a second language for three years is most likely to do which of the following when speaking English in casual conversation with teachers at school? A.Use the auxiliary "have" in place of "be" in progressive tenses B.Use incorrect word order within prepositional phrases C.Use conjunctions in place of prepositions D.Use multiple negation improperly Answer- Option (D) is correct. Multiple negation is a grammatical feature of Spanish but not of Standard English. The contrast between the two languages can cause multiple negation to persist as a speaker attempts to learn Standard English. GOT WRONG A 4-month-old-infant who has a low birth weight but passed a neonatal hearing screening was evaluated for development of communication skills. The speech- language pathologist found that the infant followed moving objects visually, showed interest in mouthing and banging objects, and began sucking in anticipation of eating, but failed to localize to environmental sounds. On the report to the infant's primary care physician, the most appropriate recommendation by the speech- language pathologist is A.consideration of auditory amplification B.hearing-loss counseling for the parents C.careful parent monitoring of the child's speech-language development D.evaluation of auditory function by an audiologist Answer- Option (D) is correct. The infant is showing normal development except for problems in localizing environmental sounds. This symptom is indicative of a possible auditory problem, making it appropriate for the infant to be referred to an audiologist for evaluation of auditory function. A 60-year-old man says that he has "trouble thinking of names and words" and that it is interfering with his job performance. The problem began three months ago after he had a minor cerebrovascular accident. He does not report any other problems. His conversation is characterized by some hesitancies, latencies, repetitions, interjections, and self-corrections. On the basis of an interview and the results of an aphasia battery, it is concluded that he has a mild aphasia. The most appropriate course of action is to A.advise the client to wait for three more months in order to allow spontaneous recovery to take place B.begin a treatment program designed to decrease dysfluencies in his speech C.offer a treatment program designed to improve word-retrieval skills D.encourage the client to increase his reading of information related to his profession in order to facilitate recall of professional terminology Answer- Option (C) is correct. The client's language reflects the word-finding difficulties of an individual with aphasia. Treatment to remediate his difficulties is appropriate. Which of the following procedures would be effective in remediating a falsetto voice for an adult male with a severe bilateral hearing loss?

A.Development of phonation from coughing B.Pushing exercises C.Manual depression of the larynx D.Manual elevation of the larynx Answer- Option (C) is correct. Manual depression of the larynx will serve to lengthen the vocal folds, allowing them to vibrate at a lower frequency. GOT WRONG Cognitive therapy for stuttering focuses on which of the following? A.Extinguishing the overt, dysfluent speech behavior by withholding positive reinforcement B.Changing distorted beliefs about self-efficacy and the need to speak with complete fluency C.Providing positive reinforcement during periods of fluent speech D.Reducing dysfluent speech behavior by using visual imaging Answer- Option (B) is correct. Changing distorted beliefs about self-efficacy and the need to speak with complete fluency represents the only answer choice that is cognitive in nature. GOT WRONG 2ND TIME A prospective client is described as a man in his forties who is under chronic stress. He uses his voice extensively in daily life has a hard-driving personality, and exhibits glottal fry. The client has the classic profile of a person at high risk for A.spastic dysphonia B.acute laryngitis C.vocal nodules D.contact ulcers Answer- Option (D) is correct. The symptoms exhibited by this patient represent a classic profile of a person who has contact ulcers. GOT WRONG Which of the following most accurately represents the etiology of cleft palate? A.Genetic factors alone B.Environmental influences alone C.Genetic factors interacting with environmental influences D.Medications taken by the mother during pregnancy Answer- Option (C) is correct. The interaction of genetic factors and environmental influences represents the etiology of cleft palate. For which individual would a recommendation for an augmentative and alternative communication (AAC) intervention be least appropriate? A.A preschool child with a language-learning disorder and highly unintelligible speech B.A teenager with a repaired cleft palate who continues to experience hypernasality

C.A young adult with severe cerebral palsy precluding functional oral communication D.A 55-year-old man who has had a laryngectomy Answer- Option (B) is correct. This is correct because someone with hypernasality would still be intelligible, and an AAC device would not be needed. Which of the following is an accurate statement about whispered speech? A.It is produced by approximating the arytenoid cartilages so that their medial surfaces are in direct contact. B.It is composed largely of aperiodic sounds. C.Spectrographic analysis of it reveals no discernible formants for the vowels. D.Most people can produce longer utterances per breath using it than they can using conventional phonation. Answer- Option (B) is correct. Whispered speech is composed largely of aperiodic sounds, as the vocal folds do not vibrate while whispering is taking place. GOT WRONG Which of the following actions will most effectively control the problem of overreferral in school screening programs that use impedance/immittance measurements? A.Obtaining the measurements in a professional sound-insulated room B.Including 500 Hz in the audiometric screening procedure C.Retesting immediately those who did not pass the first screening D.Waiting three to five weeks to retest those who did not pass the first screening Answer- Option (D) is correct. Some children may have a temporary problem due to a cold or ear infection, which may resolve in a few weeks. Six months ago, an SLP evaluated 4-year-old Molly's speech fluency during conversation. At that time, she displayed physically relaxed repetitions of words and phrases (occurring at a frequency of 2 per 100 words), and interjections such as "um" (occurring at a frequency of 1 per 100 words). She did not display any sound prolongations or facial grimaces; she did not produce any pitch rises or phonatory breaks; and she did not appear to avoid any sounds or words. Results from several formal tests suggested that her articulation and language development were within normal limits. Molly reportedly began producing repetitions and interjections at age 24 months, and the frequency of these disfluency types reportedly has remained stable since then. The SLP did not recommend speech-language intervention following the previous evaluation; however, she did provide the parents with information about fluency development, sympto Answer- Option (B) is correct. Molly's fluency development was within normal limits at the previous evaluation, and, based on the parents' report, it also seemed to be within normal limits at age 2. Further, no other concerns about Molly's communication development were mentioned in the scenario. Thus, it appears that Molly has never stuttered and her communication skills have been and continue to be within normal limits. Therefore, it is unnecessary to reevaluate her speech or enroll her in fluency therapy. GOT WRONG

The utterances above, spoken by a 3-year-old monolingual English-speaking child, indicate that the child most likely has a problem with which of the following? A.Semantic redundancy B.Syntactic relationships C.Morphological relationships D.Pragmatics Answer- Option (B) is correct. The utterances are not in the correct order, which is characteristic of a syntactic error. Which of the following is a type of perturbation that can be measured to determine the amount of noise in the voice? A.Changes in the frequency range between F1 and F2 over time B.Changes in the frequency range between F2 and F3 over time C.F3 cycle-to-cycle variations in sound energy over time D.F0 cycle-to-cycle variations in sound energy over time Answer- Option (D) is correct. Perturbation is a disturbance in the quality of the laryngeal tone, or fundamental frequency, of the voice. GOT WRONG Which of the following describes an important diagnostic distinction between apraxia of speech and dysarthria? A.Apraxia of speech is a result of lower motor neuron lesions, whereas dysarthria is the result of upper motor neuron lesions. B.Clients with apraxia of speech lack the ability to monitor reactive speech, whereas clients with dysarthria lack the ability to sequence volitional speech movements. C.Strength and coordination of the speech musculature are intact in clients with apraxia of speech, whereas slowness, weakness, incoordination, or altered tone of the speech musculature are associated with dysarthria. D.Apraxia of speech is characterized by distortions, omissions, and substitutions, whereas dysarthria is characterized by inconsistent, highly variable misarticulations. Answer- Option (C) is correct. Dysarthria is a motor speech disorder characterized by slowness, weakness, incoordination, or altered tone of the speech production mechanism. The definition of apraxia includes the absence of any deficits in strength, tone, or coordination and rather is characterized by deficits in motor planning and/or programming of speech. Naturalistic teaching chiefly involves which of the following? A.Establishing successful and useful communication B.Using multiple trials and training techniques C.Using more adult-initiated interactions than child-initiated interactions D.Using differential reinforcement, fading, and modeling Answer- Option (A) is correct. Naturalistic teaching focuses on the successful production of utterances that are useful in context for communicating. GOT WRONG

Ms. Helene, a 60-year-old woman with a suspected neurological disorder, is referred for speech-language evaluation. She achieves a score of 35/50 on a measure of confrontation object-naming ability. This score is below norms established for individuals of her age and educational level. Based on these results alone, which of the following statements can most reliably be made about Ms. Helene's disorder? A.She has anomic aphasia, which might or might not be associated with other language deficits. B.She has aphasia, but the type of aphasia cannot be specified on the basis of this test score alone. C.She does not have aphasia but probably does have a memory disturbance. D.She has difficulty with naming, but the precise nature of the deficit cannot be determined on the basis of this test score alone. Answer- Option (D) is correct. Ms. Helene has a suspected neurological disorder and she achieves a score that is below the norms for individuals her age. Given this information alone, the most that can be said is that she has difficulty with naming; the precise nature of her deficit cannot be determined. A 67-year-old male patient with no history of swallowing problems has undergone a cardiothoracic surgical procedure. Postoperatively, he is found to be aspirating while swallowing and is diagnosed with a left vocal-fold paralysis and left pharyngeal paresis. Which of the following is the most likely etiology? A.An intraoperative CVA in the right pons B.Damage to the right recurrent laryngeal nerve C.Damage to the left recurrent laryngeal nerve D.A left hemispheric stroke Answer- Option (C) is correct. The left recurrent laryngeal nerve courses under the aortic arch in its course back to innervate the left larynx and the inferior pharynx. The nerve can be damaged in cardiothoracic operations including aortic arch or valve repairs. Only the left (and not the right) recurrent laryngeal nerve has this course. GOT WRONG A team of SLPs is evaluating whether a new language intervention is suitable for use with children who are on their caseload. The clinicians read an article documenting research on the effect of a novel treatment on the language performance of 30 children with specific language impairment. The researchers administered a standardized language test to the children before and after the treatment program. The children's posttreatment scores on the test were significantly higher than their pretreatment scores. This led the researchers to conclude that the treatment was highly effective. Based on the preceding description, which of the following appears to be a significant limitation of the design of the study? Select all that apply. A.The use of a single-group pretest-posttest design B.The absence of a control group

C.The inability to rule out the possibility that the children's language scores improved for reasons oth Answer- Options (A), (B), and (C) are correct. The use of a single- group pretest-posttest design is a limitation because there is inadequate control of internal and external validity without a control group. The absence of a control group is a limitation because control groups are a way of introducing control and can better isolate the effect of the treatment. Furthermore, since it is a longitudinal study, improvement based on language development cannot be ruled out. GOT WRONG Which of the following muscles produces the opposing action to those that produce velopharyngeal closure? A.Musculus uvulae B.Levator veli palatini C.Palatoglossus D.Stylopharyngeus Answer- Option (C) is correct. Velopharyngeal closure is largely produced by soft palate elevation, and the only muscle in the list that produces soft palate depression (the opposite of soft palate elevation) is the palatoglossus. GOT WRONG Michael is a 32-month-old boy who has been receiving early intervention services over the past ten months for delayed speech and expressive-language development. Although his birth was reportedly unremarkable, Michael does have a history of recurrent otitis media with effusion. His parents described him as having been a "well-behaved and quiet baby." When Michael began receiving services, he communicated mainly through gestures and crude vocalizations. An open resting mouth position with slight tongue protrusion was sometimes noted. However, his receptive-language skills were found to be age appropriate and he showed no oral motor deficits during feeding. Michael's expressive-language skills have shown some progress since he began working with the speech-language pathologist, but he remains poorly intelligible. Michael's imitation of tongue, lip, and jaw movements is characterized by inconsistent groping and errors o Answer- Option (D) is correct. Michael's history of recurrent middle ear infections, an otolarygologist would be able to clinically manage otitis media and make provisions to obtain an audiological assessment. Michael is a 32-month-old boy who has been receiving early intervention services over the past ten months for delayed speech and expressive-language development. Although his birth was reportedly unremarkable, Michael does have a history of recurrent otitis media with effusion. His parents described him as having been a "well-behaved and quiet baby." When Michael began receiving services, he communicated mainly through gestures and crude vocalizations. An open resting mouth position with slight tongue protrusion was sometimes noted. However, his receptive-language skills were found to be age appropriate and he showed no oral motor deficits during feeding. Michael's expressive-language skills have shown some progress since he began working with the speech-language pathologist, but he remains poorly intelligible. Michael's imitation of tongue, lip, and jaw movements is characterized by inconsistent groping and errors o Answer- Option (A) is correct.

Articulation characterized by groping, inconsistency, and errors of sound and syllable sequencing strongly suggests developmental apraxia of speech. GOT WRONG Michael is a 32-month-old boy who has been receiving early intervention services over the past ten months for delayed speech and expressive-language development. Although his birth was reportedly unremarkable, Michael does have a history of recurrent otitis media with effusion. His parents described him as having been a "well-behaved and quiet baby." When Michael began receiving services, he communicated mainly through gestures and crude vocalizations. An open resting mouth position with slight tongue protrusion was sometimes noted. However, his receptive-language skills were found to be age appropriate and he showed no oral motor deficits during feeding. Michael's expressive-language skills have shown some progress since he began working with the speech-language pathologist, but he remains poorly intelligible. Michael's imitation of tongue, lip, and jaw movements is characterized by inconsistent groping and errors o Answer- Option (D) is correct. Michael's case history suggests that his poor intelligibility is tied to his inconsistent sequencing of speech sounds and syllables. GOT WRONG Michael is a 32-month-old boy who has been receiving early intervention services over the past ten months for delayed speech and expressive-language development. Although his birth was reportedly unremarkable, Michael does have a history of recurrent otitis media with effusion. His parents described him as having been a "well-behaved and quiet baby." When Michael began receiving services, he communicated mainly through gestures and crude vocalizations. An open resting mouth position with slight tongue protrusion was sometimes noted. However, his receptive-language skills were found to be age appropriate and he showed no oral motor deficits during feeding. Michael's expressive-language skills have shown some progress since he began working with the speech-language pathologist, but he remains poorly intelligible. Michael's imitation of tongue, lip, and jaw movements is characterized by inconsistent groping and errors o Answer- Option (A) is correct. Toddlers and preschoolers respond better to games and play activities than to structured exercises. A 9-month-old child was observed during a speech-language evaluation. To express herself, the child occasionally touched her mother, gained eye contact, and then gestured toward an object. If the child's development is normal, within the next month or so the child will begin to A.use consistent sound and intonation patterns as signals for specific intentions B.reach for objects that she desires C.establish joint reference with her caretaker D.use recognizable words and phrases to express her intentions Answer- Option (A) is correct. In normal development, a child begins to use vocalizations to express specific intentions at around 10 months of age.

For a patient with communication and swallowing disorders secondary to acquired immunodeficiency syndrome (AIDS), a speech-language pathologist will most appropriately A.serve only as a consultant to others who are directly involved in the patient's care B.provide treatment on a monthly basis C.provide treatment only as prescribed by the patient's physician D.provide treatment in consultation with the patient's primary-care physician or medical team Answer- Option (D) is correct. Treatment in consultation with the patient's primary-care physician or medical team would provide the information needed to determine the best management of the patient. GOT WRONG An otolaryngologist has referred a 45-year-old man for voice treatment following medialization thyroplasty for a paralyzed vocal fold. Which of the following is the most appropriate therapeutic strategy for the SLP to use? A.Assisting the patient to produce a soft glottal attack B.Digitally manipulation of the patient's neck to reduce strap-muscle tension C.Assisting the patient to produce a hard glottal attack D.Employing techniques aimed at increasing airflow Answer- Option (C) is correct. Medialization thyroplasty moves the paralyzed vocal fold closer to the mid-glottis to allow better compensation by the unaffected fold. Only the production of a hard glottal attack addresses the compensatory behavior. GOT WRONG Compared with children who do not have language disorders, children with language disorders tend to A.take more conversational turns B.initiate topics and direct the flow of conversation more C.ask fewer open-ended questions D.initiate more indirect requests Answer- Option (C) is correct. Children with language disorders tend to ask fewer open-ended questions than do children who are developing normally. Which of the following types of cerebral palsy is characterized by slow, arrhythmic writhing and involuntary movements of the extremities? A.Athetosis B.Spasticity C.Hypotonia D.Bulbar palsy Answer- Option (A) is correct. Athetosis is a type of cerebral palsy that is characterized by slow, arrhythmic writhing and involuntary movements of the extremities. GOT WRONG

Intervention from an SLP for a nursing-home resident who is in a late stage of progressive dementia will most effectively focus on A.conversational intelligibility B.recall of salient vocabulary words C.comprehension of social discourse D.assisting in communication routines Answer- Option (D) is correct. Intervention from an SLP for a nursing-home resident in a late stage of progressive dementia would most effectively focus on assisting the resident with daily communication functions. GOT WRONG For a test of expressive morphology and syntax for speakers of African American Vernacular English (AAVE), the test item that would be considered LEAST biased against such speakers would be one requiring A.use of the auxiliary verb "be" in the present progressive tense B.use of the past-tense ending "-ed" C.use of sentences with multiple negation D.agreement of personal pronouns with their antecedents in gender and number Answer- Option (D) is correct. The morphological feature listed is one in which African American Vernacular English (AAVE) does not differ from Standard American English (SAE). GOT WRONG In the treatment of acute Wernicke's aphasia, the initial focus should be on A.encouraging self-monitoring of the adequacy of verbal output B.increasing the rate of speech C.improving the client's ability to elaborate verbally D.increasing the complexity of sentence structures Answer- Option (A) is correct. Wernicke's aphasia results in deficits related to the ability to recognize the adequacy of one's verbal production. GOT WRONG Research regarding the use of intensive phonemic-awareness treatment for children who have difficulty learning to read has demonstrated that the treatment A.is effective only for children from 4 to 8 years old B.is effective mainly with children who have remediated all phonological process errors C.is effective only when combined with a supplemental literacy program D.might have no direct relationship to improvement in reading abilities Answer- Option (D) is correct. Intensive phonemic-awareness treatment programs are thought to improve reading by training children to better differentiate and process speech sounds. However, to date, research has not successfully separated the effects of intensive intervention, so no direct relationship has yet been proved.

GOT WRONG

Which of the following would be most likely to help a client who has aphonia? A.Development of phonation through coughing or throat clearing B.Pairing the production of /s/ and /z/ C.Respiratory exercises D.Easy initiation of phonation Answer- Option (A) is correct. Development of phonation through coughing or throat clearing is an effective technique in the treatment of aphonia. GOT WRONG A child with discourse problems is most likely to need remediation directed at which of the following? A.Morphology B.An initial lexicon C.Gestural communication D.Cohesive devices Answer- Option (D) is correct. Cohesive devices, such as prenominal references, coordinating conjunctions, and conjunctive adverbs, are used to link clausal and sentential elements to form a coherent and unified message. GOT WRONG In the treatment of voice disorders, the chewing technique is used to do which of the following? A.Improve control of loudness B.Increase pitch range during voice production C.Increase air supply during voice production D.Reduce tension in the laryngeal area Answer- Option (D) is correct. The chewing technique is used to reduce muscular tension in the laryngeal area. In terms of communication impairment, an adult with Alzheimer's-type dementia tends to differ from an adult with aphasia associated with a CVA in that A.repetition abilities are typically more seriously impaired in the adult with dementia B.the adult with dementia generally experiences greater dysfluency C.the adult with dementia is generally more aware of any disruptions in communication D.the capacity of the adult with aphasia to make appropriate comments about recent events is generally better Answer- Option (D) is correct. Adults with dementia typically have impaired short-term memory abilities. Adults with aphasia are more likely to recall recent events and consequently would be more likely to make appropriate comments about recent events when compared to those with dementia. GOT WRONG 2ND TIME

An SLP is planning treatment for a 5-year-old child with multiple speech-production errors. The most effective strategy the clinician can use to treat the child is to A.arrange error sounds by developmental pattern and correct them sound by sound B.start with sounds the child can make and use them as bridges to error sounds C.teach sounds in isolation, then use nonsense syllables, and then build to words D.delineate phonological processes in operation and address them through minimal- contrast pairs Answer- Option (D) is correct. The most efficient procedure for the child would be for the speech-language pathologist to define the phonological processes in operation and address them through minimal-contrast pairs. GOT WRONG A teacher asks the speech-language pathologist for advice regarding a child who talks excessively during class, rarely listens to instructions, and does work only intermittently. Attempts at alternative seating for the child have not been successful. Of the following, which is the most appropriate recommendation that the speech- language pathologist can provide to the teacher? A.Have the school counselor consider working with the child and the parents on self- control and discipline B.Put the child on a management system for classroom behavior C.Refer the child for evaluation by members of the child-study team D.Suggest remedial speech-language services for the child to improve the child's interactive communication Answer- Option (C) is correct. The child has a behavioral problem that should be evaluated for the purposes of identification and management planning. GOT WRONG A disfluent 4-year-old child is referred to an SLP for assessment. Which of the following is most important for the SLP to consider in deciding whether the child is developmentally nonfluent or stuttering? A.The length of time the child has been disfluent B.The rate at which the child talks C.The nature and frequency of the child's disfluencies D.The child's comments to the clinician about the disfluencies Answer- Option (C) is correct. The nature and frequency of the child's repetitions will help distinguish between normal disfluency and the type of stuttering for which remediation is indicated. Which of the following provides the most important diagnostic information to an SLP making a differential diagnosis between childhood apraxia of speech and flaccid dysarthria in a child? A.The child's articulation performance at the sentence level B.A history of the child's development of chewing, eating, and swallowing C.A history of the child's language development

D.The child's willingness to function in sociocommunicative events Answer- Option (B) is correct. A child with childhood apraxia of speech does not have difficulties with chewing, eating, and swallowing, whereas a child with flaccid dysarthria is likely to have such difficulties. GOT WRONG A speech-and-hearing clinic has recently opened, but referrals are slow in coming. Which of the following would be most appropriate and effective for the clinic's director to do first? A.Ask local hospitals to provide names of recent clients likely to need speech- language services B.Identify and define the major consumer groups and referral sources, and develop a plan to reach them C.Identify the weaknesses in the competition, and inform consumer groups and referral sources of the weaknesses D.Wait for demand to increase on its own, because marketing speech-language services is against the ASHA Code of Ethics Answer- Option (B) is correct. The clinical director of a new speech-and-hearing clinic would most appropriately prospect for referrals by identifying major consumer groups and creating a plan to contact them. Native speakers of a language possess several capacities or abilities that provide insight into their language competence. Sentences such as "Visiting friends can be a nuisance" are especially useful to test a person's ability to A.recognize syntactic ambiguity B.interpret metaphoric language C.distinguish homophones by means of syntactic cues D.recognize a semantically anomalous sentence Answer- Option (A) is correct. There are two ways to parse or interpret the structure of the sentence "Visiting friends can be a nuisance." One interpretation is that it is bothersome to visit friends; the other is that friends who have come for a visit are bothersome. Therefore, this sentence would be appropriate as part of a test of a person's ability to recognize syntactic ambiguity. GOT WRONG A 6-year-old child produces [t] for /s/, [d] for /z/, [p] for /f/, and [b] for /v/. Intervention for this problem would target language at the level of A.morphology B.syntax C.phonology D.semantics Answer- Option (C) is correct. The speech patterns described in the question stem all pertain to speech sound production. Phonology is the aspect of language that deals with speech sound production.