Mr. Okafor, age 62, receives outpatient treatment for aphasia. For the past month his wife has told the SLP at every visit that she feels hopeless, has stopped seeing friends, and sleeps only a few hours a night. Her distress has not eased with education and support about aphasia. Which of the following is the MOST appropriate way for the SLP to respond to Mrs. Okafor's distress?

Acknowledge her feelings and refer her to a mental health professional

Explain that caregiver emotions are outside the SLP's scope to discuss

Begin weekly counseling sessions with her to treat the depressed mood

Reassure her that her husband's language is likely to recover fully

Amara, age 5, is scheduled for an adenoidectomy next month. During a preschool speech evaluation, the SLP observes a bifid uvula, a bluish translucent line along the midline of the soft palate, and a notch that can be palpated at the posterior border of the hard palate. Resonance is mildly hypernasal. Which of the following is the MOST appropriate action for the SLP?

Notify the surgeon of a possible submucous cleft before the surgery

Recommend blowing and sucking exercises to strengthen the soft palate

Begin therapy for hypernasality and reassess resonance after the surgery

Document the findings and rescreen resonance at the next annual review

A 59-year-old woman in the intensive care unit has a tracheostomy, requires mechanical ventilation, and is too medically unstable to leave the unit. Nursing reports copious secretions and a wet vocal quality. The physician requests an instrumental examination before any oral intake. Which of the following examinations is the MOST appropriate choice for this patient?

Flexible endoscopic evaluation of swallowing

High-resolution pharyngeal manometry

Videofluoroscopic swallowing study

Ms. Nguyen, a 34-year-old elementary teacher, has had 4 months of hoarseness and vocal fatigue. A laryngologist diagnoses bilateral vocal fold nodules and refers her to the SLP. She talks over classroom noise for most of the day and drinks little water. Which first-line management is MOST appropriate for Ms. Nguyen?

Vocal hygiene education with resonant voice therapy

Botulinum toxin injection with follow-up therapy

Pushing and hard glottal attack exercises

Phonosurgical removal followed by complete voice rest

A 55-year-old woman with a 30-year smoking history has a low-pitched, rough voice. The otolaryngologist reports bilateral polypoid degeneration (Reinke's edema), with gelatinous fluid that increases the mass of the vibrating cover of both vocal folds. In which layer of the vocal fold does this fluid accumulate?

Superficial layer of the lamina propria

Deep layer of the lamina propria

Thyroarytenoid (vocalis) muscle

Intermediate layer of the lamina propria

A 34-year-old teacher with vocal fold nodules tells the SLP, "I know I should rest my voice and drink more water, but with 30 students and no breaks, I just can't." Which of the following responses by the SLP is an example of reflective listening?

"You want to protect your voice, and your workday makes that hard."

"Many teachers say that, and most of them manage it in the end."

"If you do not make these changes, the nodules will not resolve."

"Have you tried keeping a water bottle on your desk during class?"

The parents of a 4-year-old ask whether his "tongue-tie" should be clipped to prevent speech problems. The SLP sees a short lingual frenulum and a slight notch in the tongue tip on protrusion. He raises the tongue tip to the alveolar ridge with his mouth open, licks his lips, and produces /t/, /d/, /n/, /l/, and /s/ accurately in conversation. He has no feeding difficulty. How should the SLP answer the parents' question about clipping the frenulum?

Explain that tongue mobility is adequate for speech and no treatment is indicated

Recommend a frenotomy now so that later-developing sounds will be learned correctly

Begin tongue-tip stretching and lifting exercises to lengthen the lingual frenulum

Begin articulation therapy for tongue-tip sounds as a precaution against errors

A patient with a cuffed tracheostomy tube is breathing without ventilator support and is referred for a one-way speaking valve trial. A nurse suggests keeping the cuff inflated during the trial to protect the airway. Which of the following is the MOST accurate response?

The cuff must be fully deflated so that exhaled air can pass around the tube

The cuff should be partly inflated so that some air still reaches the vocal folds

The cuff should stay inflated so that secretions cannot reach the lower airway

The cuff status is unimportant because the valve opens in both directions

A 15-year-old competitive swimmer has episodes of throat tightness and noisy inhalation during hard races that resolve within minutes of stopping. Her inhaler does not help. A physician's laryngoscopy during symptoms shows the vocal folds adducting on inspiration, and pulmonary testing is otherwise normal. Which intervention should the SLP provide?

Relaxed-throat breathing techniques for symptom control

Effortful closure exercises to improve glottal adduction

Vocal function exercises performed twice each, twice daily

Confidential voice therapy to limit vocal fold impact

Praxis 5331 Speech-Language Pathology

Free Praxis 5331 Speech-Language Practice Questions

10 sample questions for the Praxis 5331 Speech-Language Pathology, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Foundations and Professional Practice, Screening, Assessment, Evaluation, and Diagnosis, Planning, Implementation, and Evaluation of Treatment.

Question 1 · Foundations and Professional Practice
A 52-year-old woman has a breathy, weak voice 2 weeks after a total thyroidectomy. Laryngoscopy by the otolaryngologist shows the left vocal fold immobile in the paramedian position, consistent with injury to the left recurrent laryngeal nerve.
Which of the following left-sided intrinsic laryngeal muscles would be expected to retain its normal innervation?
- A.Thyroarytenoid
- B.Cricothyroid
- C.Posterior cricoarytenoid
- D.Lateral cricoarytenoid
Show answer and explanation
Answer: B. Cricothyroid
The cricothyroid is supplied by the external branch of the superior laryngeal nerve, so it is spared when the recurrent laryngeal nerve is injured. Every other intrinsic laryngeal muscle, including the posterior cricoarytenoid, is supplied by the recurrent laryngeal nerve. Choosing the posterior cricoarytenoid confuses its unique action (the only abductor) with a unique nerve supply.
Question 2 · Foundations and Professional Practice
Mr. Okafor, age 62, receives outpatient treatment for aphasia. For the past month his wife has told the SLP at every visit that she feels hopeless, has stopped seeing friends, and sleeps only a few hours a night. Her distress has not eased with education and support about aphasia.
Which of the following is the MOST appropriate way for the SLP to respond to Mrs. Okafor's distress?
- A.Explain that caregiver emotions are outside the SLP's scope to discuss
- B.Begin weekly counseling sessions with her to treat the depressed mood
- C.Reassure her that her husband's language is likely to recover fully
- D.Acknowledge her feelings and refer her to a mental health professional
Show answer and explanation
Answer: D. Acknowledge her feelings and refer her to a mental health professional
SLPs counsel clients and families about feelings and adjustments related to the communication disorder, but persistent signs of depression call for referral to a mental health professional. Treating the mood disorder goes beyond the SLP's scope, and promising full recovery is false reassurance. Refusing to discuss her emotions at all is also wrong, because listening and supportive counseling are within scope.
Question 3 · Screening, Assessment, Evaluation, and Diagnosis
Amara, age 5, is scheduled for an adenoidectomy next month. During a preschool speech evaluation, the SLP observes a bifid uvula, a bluish translucent line along the midline of the soft palate, and a notch that can be palpated at the posterior border of the hard palate. Resonance is mildly hypernasal.
Which of the following is the MOST appropriate action for the SLP?
- A.Recommend blowing and sucking exercises to strengthen the soft palate
- B.Begin therapy for hypernasality and reassess resonance after the surgery
- C.Notify the surgeon of a possible submucous cleft before the surgery
- D.Document the findings and rescreen resonance at the next annual review
Show answer and explanation
Answer: C. Notify the surgeon of a possible submucous cleft before the surgery
A bifid uvula, a translucent midline of the soft palate (zona pellucida), and a notch in the posterior hard palate are the classic signs of a submucous cleft. Removing the adenoids can take away the tissue the velum closes against and cause marked hypernasality, so the surgeon needs this information before operating. Blowing exercises and therapy do not correct a structural velopharyngeal problem.
Question 4 · Screening, Assessment, Evaluation, and Diagnosis
A 59-year-old woman in the intensive care unit has a tracheostomy, requires mechanical ventilation, and is too medically unstable to leave the unit. Nursing reports copious secretions and a wet vocal quality. The physician requests an instrumental examination before any oral intake.
Which of the following examinations is the MOST appropriate choice for this patient?
- A.High-resolution pharyngeal manometry
- B.Flexible endoscopic evaluation of swallowing
- C.Barium esophagram
- D.Videofluoroscopic swallowing study
Show answer and explanation
Answer: B. Flexible endoscopic evaluation of swallowing
The endoscopic examination can be completed at the bedside without radiation or transport and gives a direct view of secretions, laryngeal anatomy, and airway protection, which matches this patient's needs. The videofluoroscopic study is the tempting choice because it shows all phases of the swallow, but it requires transport to radiology and positioning that an unstable, ventilator-dependent patient may not tolerate.
Question 5 · Planning, Implementation, and Evaluation of Treatment
Ms. Nguyen, a 34-year-old elementary teacher, has had 4 months of hoarseness and vocal fatigue. A laryngologist diagnoses bilateral vocal fold nodules and refers her to the SLP. She talks over classroom noise for most of the day and drinks little water.
Which first-line management is MOST appropriate for Ms. Nguyen?
- A.Vocal hygiene education with resonant voice therapy
- B.Botulinum toxin injection with follow-up therapy
- C.Pushing and hard glottal attack exercises
- D.Phonosurgical removal followed by complete voice rest
Show answer and explanation
Answer: A. Vocal hygiene education with resonant voice therapy
Nodules result from phonotrauma, so first-line management is behavioral: vocal hygiene (hydration, amplification, less loud talking) combined with direct therapy such as resonant voice to reduce vocal fold impact stress. Surgery is considered only if nodules persist after therapy. Pushing and hard glottal attack increase adduction force and would aggravate the lesions, and botulinum toxin is a treatment for spasmodic dysphonia.
Question 6 · Foundations and Professional Practice
A 55-year-old woman with a 30-year smoking history has a low-pitched, rough voice. The otolaryngologist reports bilateral polypoid degeneration (Reinke's edema), with gelatinous fluid that increases the mass of the vibrating cover of both vocal folds.
In which layer of the vocal fold does this fluid accumulate?
- A.Deep layer of the lamina propria
- B.Thyroarytenoid (vocalis) muscle
- C.Superficial layer of the lamina propria
- D.Intermediate layer of the lamina propria
Show answer and explanation
Answer: C. Superficial layer of the lamina propria
Reinke's space is the superficial layer of the lamina propria, the loose, gelatinous layer that together with the epithelium forms the vibrating cover. Fluid collecting there adds mass to the cover and lowers pitch. The intermediate and deep layers form the vocal ligament (the transition), and the thyroarytenoid muscle forms the body, so they are not the site of this edema.
Question 7 · Foundations and Professional Practice
A 34-year-old teacher with vocal fold nodules tells the SLP, "I know I should rest my voice and drink more water, but with 30 students and no breaks, I just can't."
Which of the following responses by the SLP is an example of reflective listening?
- A."You want to protect your voice, and your workday makes that hard."
- B."Many teachers say that, and most of them manage it in the end."
- C."If you do not make these changes, the nodules will not resolve."
- D."Have you tried keeping a water bottle on your desk during class?"
Show answer and explanation
Answer: A. "You want to protect your voice, and your workday makes that hard."
A reflection restates the content and feeling of what the client said, here both the wish to change and the barrier, which shows understanding and invites the client to say more. The question about a water bottle is advice in the form of a closed question. The warning about the nodules is confrontation, and the comment about other teachers is reassurance that dismisses her concern.
Question 8 · Screening, Assessment, Evaluation, and Diagnosis
The parents of a 4-year-old ask whether his "tongue-tie" should be clipped to prevent speech problems. The SLP sees a short lingual frenulum and a slight notch in the tongue tip on protrusion. He raises the tongue tip to the alveolar ridge with his mouth open, licks his lips, and produces /t/, /d/, /n/, /l/, and /s/ accurately in conversation. He has no feeding difficulty.
How should the SLP answer the parents' question about clipping the frenulum?
- A.Recommend a frenotomy now so that later-developing sounds will be learned correctly
- B.Begin tongue-tip stretching and lifting exercises to lengthen the lingual frenulum
- C.Begin articulation therapy for tongue-tip sounds as a precaution against errors
- D.Explain that tongue mobility is adequate for speech and no treatment is indicated
Show answer and explanation
Answer: D. Explain that tongue mobility is adequate for speech and no treatment is indicated
The decision rests on function, not appearance: this child elevates and protrudes the tongue tip well enough to produce the lingual-alveolar sounds accurately, and he feeds without difficulty. Evidence that a short lingual frenulum causes speech sound errors is limited, so surgery to prevent speech problems is not supported when mobility is adequate. Stretching exercises do not lengthen the frenulum, and therapy is not indicated when no sounds are in error.
Question 9 · Screening, Assessment, Evaluation, and Diagnosis
A patient with a cuffed tracheostomy tube is breathing without ventilator support and is referred for a one-way speaking valve trial. A nurse suggests keeping the cuff inflated during the trial to protect the airway. Which of the following is the MOST accurate response?
- A.The cuff should be partly inflated so that some air still reaches the vocal folds
- B.The cuff should stay inflated so that secretions cannot reach the lower airway
- C.The cuff status is unimportant because the valve opens in both directions
- D.The cuff must be fully deflated so that exhaled air can pass around the tube
Show answer and explanation
Answer: D. The cuff must be fully deflated so that exhaled air can pass around the tube
A one-way valve opens on inhalation and closes on exhalation, so exhaled air must travel around the tube and up through the larynx; with the cuff inflated the patient cannot exhale, which is a life-threatening error. An inflated cuff does not prevent aspiration in any case, because material has already passed the vocal folds by the time it reaches the cuff.
Question 10 · Planning, Implementation, and Evaluation of Treatment
A 15-year-old competitive swimmer has episodes of throat tightness and noisy inhalation during hard races that resolve within minutes of stopping. Her inhaler does not help. A physician's laryngoscopy during symptoms shows the vocal folds adducting on inspiration, and pulmonary testing is otherwise normal.
Which intervention should the SLP provide?
- A.Relaxed-throat breathing techniques for symptom control
- B.Effortful closure exercises to improve glottal adduction
- C.Vocal function exercises performed twice each, twice daily
- D.Confidential voice therapy to limit vocal fold impact
Show answer and explanation
Answer: A. Relaxed-throat breathing techniques for symptom control
Vocal folds that adduct on inspiration during exertion, with no response to an inhaler, indicate paradoxical vocal fold motion (inducible laryngeal obstruction), which a physician diagnoses. The SLP teaches relaxed-throat or rescue breathing, such as a quick sniff followed by a slow exhale through pursed lips, to open the glottis during episodes. Exercises that increase glottal closure would work against that goal, and the other techniques target voice quality, not breathing.

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