* Read the article on page 178.
* Take the test, recording your answers in the test answers section (Section B) of the CE enrollment form. Each question has only one correct answer.
* Complete registration information (Section A) and course evaluation (Section C).
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Registration Deadline: August 31, 2011
The authors have disclosed that they have no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.
Lippincott Williams & Wilkins, publisher of Journal of Neuroscience Nursing, will award 2.0 contact hours for this continuing nursing education activity.
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CE TEST QUESTIONS
GENERAL PURPOSE: To familiarize registered professional nurses with a study evaluating "red flag" diagnoses for patients who are more likely to experience silent aspiration.
LEARNING OBJECTIVES: After reading this article and taking this test, professional nurses will be able to:
1. Discuss the scope of the problem of aspiration and silent aspiration, their evaluation, and the implications for nursing intervention.
2. Explain the purpose, methodology and results of the study discussed regarding incidence of silent aspiration.
1. The purpose of this retrospective study of silent aspiration is to
a. determine when is the most appropriate time to evaluate patients for silent aspiration.
b. evaluate the ability of diagnostic tests to identify silent aspiration patients.
c. assess teaching methods about aspiration symptoms for patients and family members.
d. increase nursing staff awareness of the "red flag" diagnostic pathology groups.
2. The literature documents the prevalence of aspiration in patients with a history of stroke or other neurological disorders as
a. approximately 10%.
b. between 14% and 71%.
c. between 78% and 82%.
d. approximately 95%.
3. The passage of food or liquids through and below the level of the true vocal folds without producing a reflexive cough is referred to as
a. laryngeal closure.
b. overt aspiration.
c. silent aspiration.
d. reflexive adduction of the vocal folds.
4. The gold standard of swallow assessment is
a. modified barium procedure.
c. fiberoptic endoscopic evaluation (FEES).
d. scintigraphic detection of salivary aspiration using radioactive technetium.
5. Clinical bedside swallow assessments
a. have been used in the past without success.
b. are performed by taking X-rays during various phases of eating and drinking.
c. are no longer performed because of the high risk of choking and aspiration.
d. are done by evaluating for distress as a patient eats varied food textures.
6. All of the following were administered to the study subjects except
a. five sips of thin barium liquid.
b. five sips of "honey" consistency thickened barium liquid.
c. five 5-ml doses of pureed/pudding barium paste material.
d. five 5-ml doses of "nectar" consistency thickened barium liquid.
7. What percentage of the 2,000 patients referred for video fluoroscopy evaluation for this study actually aspirated?
8. Of the patients that aspirated in this study, 54.5% had
a. aspiration without a cough reflex.
b. aspiration with a delayed vagal-tracheal cough reflex.
c. aspiration with an immediate cough reflex at the vocal folds.
d. laryngeal penetration above the vocal folds.
9. Among the study patients who aspirated, there were
a. more females than males.
b. more younger patients than older patients.
c. no statistical differences related to ethnicity of patients.
d. no statistically significant demographic results.
10. Among diagnoses, the highest rates of aspiration occurred in patients diagnosed with
a. brainstem stroke.
b. chronic obstructive pulmonary disease/pulmonary diagnoses.
c. dementia/Alzheimer's Disease.
d. neurodegenerative pathologies.
11. The highest "silent aspiration" rates occurred with which diagnosis?
b. brain cancer
c. heart-related conditions
d. closed head injury
12. Clinical symptoms associated with silent aspiration include all of the following except
a. wet, phlegmy vocal quality.
b. dysarthria of speech.
c. raspy, harsh-sounding speech.
d. difficulty controlling secretions.
13. Which types of food or liquids were aspirated most frequently by the study subjects?
a. thin liquids
b. puree texture
c. "honey" consistency thickened liquid
d. "nectar" consistency thickened liquid
14. What percentage of subjects who aspirated had an abnormal epiglottic movement pattern?
15. Of the subjects who aspirated, 28.5% were recommended for placement on
a. a soft solid oral diet.
b. a thickened, pureed oral diet.
c. a liquid-only oral diet.
d. non-oral nutritional intake.
16. Aspiration can lead to physiologic pulmonary changes such as
a. stronger elastic recoil.
b. premature airway closure associated with ventilation-perfusion mismatch.
c. enhanced diffusion capacity for oxygen and carbon monoxide.
d. increased expiratory flow.
17. Of the patients referred for aspiration evaluation who had a generic swallow complaint such as "things get stuck,"
a. 20% were aspirators.
b. 34% were aspirators.
c. 58% were aspirators.
d. 80% were aspirators.
18. Nurses caring for patients with a "red flag" diagnosis for silent aspiration should
a. ask to have their diet changed to pureed food or liquid diet.
b. encourage patient to eat foods with a wide variety of consistencies.
c. collaborate with a speech-language pathologist for aspiration evaluation.
d. have the patient practice coughing upon request to strengthen cough reflex.