| Course | NR 548 Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner |
|---|---|
| Week | 3 |
| Paper type | Mental status write-up |
| Length | About 1,110 words, 2 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Psychiatric-Mental Health Nurse Practitioner (PMHNP) |
| Updated | September 2026 |
Free sample paper for NR 548 Week 3
Mental Status Write-Up: A 52-Year-Old Patient's First Evaluation Recorded Domain by Domain as Observations a Second Examiner Could Check, With the First Draft's Adjectives Shown Beside the Revision
Student Name
College of Nursing, Chamberlain University
NR 548: Psychiatric Assessment for Psychiatric-Mental Health Nurse Practitioner
Instructor Name
Month Day, Year
Mental Status Write-Up: A 52-Year-Old Patient's First Evaluation Recorded Domain by Domain as Observations a Second Examiner Could Check, With the First Draft's Adjectives Shown Beside the Revision
Purpose and Context
This mental status examination records a first evaluation of a 52-year-old warehouse operations manager at a community mental health clinic, referred for depression after a layoff six weeks earlier and a marital separation three months before. The interview lasted about 55 minutes. I have written each domain as what was seen and heard, so that a second examiner reading the note could picture the patient and check the conclusions. For three domains, I show my first draft beside the revision, because the first draft was mostly adjectives and illustrates the problem this write-up was meant to fix. Shea (2017) describes the mental status examination as the part of the interview most at risk of becoming a set of unsupported labels, and the revision tries to avoid that.
Appearance
First draft: Disheveled, appears older than stated age.
Revision: Wearing a gray work jacket over a T-shirt with a food stain on the front, jeans and work boots. Beard growth of several days. Hair uncombed at the back. Eyes red-rimmed. Deep creases across the forehead. Smelled faintly of alcohol at the start of the interview, not of alcohol on breath during close conversation later. No visible injuries or scars.
The revision lets a reader judge self-care for themselves and records the alcohol odor, which the first draft omitted and which matters for the substance history.
Behavior and Psychomotor Activity
Sat in the chair nearest the door, leaning forward with elbows on knees for most of the interview. Made eye contact when answering but looked at the floor while listening. Turned a set of keys over in the right hand throughout. When asked about firearms, sat back abruptly and folded both arms, holding that posture for about two minutes before leaning forward again. No tremor of the outstretched hands. Gait steady on entering and leaving. No abnormal movements.
Speech
First draft: Speech normal.
Revision: Low volume, so that I leaned in twice to hear. Slow rate, with pauses of three to five seconds before answering most questions about mood and the future, and shorter pauses for factual questions about work. Answers brief, often one sentence, expanding only when asked about the warehouse, where the patient spoke for a minute or more with more variation in tone. Articulation clear. No pressured speech.
"Normal" told a reader nothing. The revision records the latency, which is one of the most useful observable signs of depression, and the one topic that changed it.
Mood and Affect
Mood, in the patient's words: "Like I'm at the bottom of a hole and nobody's throwing a rope."
Affect: Restricted in range and mostly sad, with tearfulness twice, once when mentioning the patient's adult daughter and once when describing clearing out the office. Brief, genuine smile when describing a former coworker's retirement party. Congruent with the stated mood. Not labile.
Quoting the mood and describing the affect separately lets a reader see that they agree, which matters because affect that contradicts reported mood would change the interpretation.
Thought Process and Content
Process: Answers stayed on topic and followed the questions. When describing the layoff, the patient moved logically from the announcement to the final day to the current finances. No loosening of associations, flight of ideas or thought blocking. Inferred from the coherence of answers across the interview.
Content: Preoccupied with having failed as a provider and with the separation, returning to both several times without being asked. Stated that "everyone would be better off" if the patient were gone. Endorsed nightly or near-nightly thoughts of suicide for about two weeks, centered on a handgun kept in a locked case at home. Denied intent to act and denied any plan for when or where. Denied thoughts of harming anyone else. No delusional beliefs elicited; the belief of being a burden was held with conviction but was understandable in context and not fixed against evidence, since the patient conceded that the daughter would be devastated.
Perception
Reported no voices and no visions. Nothing in the interview suggested a response to unseen stimuli; attention stayed with the conversation throughout.
Cognition
Alert. Oriented to date, place and the purpose of the visit. Recalled three words immediately and two of three after five minutes, the third with a category cue. Serial sevens: 93, 86, 79, then an error at 73, then stopped, saying, "I can't think straight lately." Named the current and previous presidents. Formal cognitive screening was not done at this visit; the pattern is consistent with the effect of depression on attention but should be rechecked when mood improves and after a period without alcohol.
Insight and Judgment
First draft: Insight fair, judgment fair.
Revision: Insight: recognized being depressed and said, "I know I'm not right." Did not see the drinking as a problem, describing it as "just to sleep." Judgment: attended the appointment after a primary care referral and answered difficult questions; kept a loaded handgun accessible while having suicidal thoughts, but agreed later in the interview to discuss storing it elsewhere.
"Fair" was a verdict with nothing under it. The revision gives the evidence for each and shows that insight is partial in a specific way: present for mood, absent for alcohol.
What the Examination Supports
The observations support a depressive syndrome with psychomotor slowing, prominent hopelessness and guilt, active suicidal thoughts with an identified method and no stated intent, and heavy alcohol use with limited insight. They do not suggest psychosis or delirium. The cognitive findings are mild and nonspecific. The suicidal ideation, the method and the alcohol use require a structured risk assessment, which follows in a separate note, and the Columbia Suicide Severity Rating Scale will be used to organize it (Posner et al., 2011), followed by a written safety plan built with the patient (Stanley & Brown, 2012).
Two findings deserve a second look at the next visit. The alcohol odor at the start of the interview suggests drinking the night before or that morning, which should be asked about directly. And the cognitive findings should be repeated after a period of reduced drinking, since both depression and alcohol can impair attention and recall, and the note should not attribute them to either until they are rechecked.
References
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Shea, S. C. (2017). Psychiatric interviewing: The art of understanding (3rd ed.). Elsevier.
Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256-264. https://doi.org/10.1016/j.cbpra.2011.01.001
The Chamberlain NR 548 Week 3 instructions
The third week asks for a complete mental status examination write-up. Instructions commonly request each domain with specific findings, appropriate terminology, pertinent positives and negatives and a brief interpretation. Describe appearance as what you saw, not whether it was appropriate. Record behavior, including what the person did with hands, eyes and posture. Describe speech by rate, volume, latency and quantity rather than calling it normal. Quote mood in the patient's words and describe affect separately, noting whether they agree. Say what thought process was inferred from. Record thought content, including suicidal and homicidal ideation, specifically. Give the cognitive tasks and results. Support insight and judgment with evidence. End with what the findings support. Cite an interviewing or assessment source in APA 7.
Inside the NR 548 Week 3 example
The write-up opens with the context of the evaluation and explains that each domain is written as observation, citing an interviewing text on the risk of labels. Appearance, speech and insight each show a first draft beside a revision: a stained T-shirt and days of beard growth instead of disheveled, low volume and long latencies instead of normal speech, and insight present for depression but absent for drinking instead of fair. Behavior records posture, a set of keys turned in one hand and arms folded when firearms came up. Mood is quoted and affect described. Thought content records nightly suicidal thoughts with a method and no intent. Cognition gives recall and serial sevens results. The close lists what the findings support and what to recheck.
Reading the NR 548 Week 3 grading rubric
Mental status write-ups are generally assessed on completeness across domains, descriptive accuracy, correct terminology, attention to safety-relevant content and a reasonable interpretation. Writing observations a second examiner could check, rather than conclusions, is what instructors look for above all. Showing revisions from adjectives to description demonstrates understanding of that standard. Speech described by latency and volume, mood quoted and affect described separately, and insight supported by evidence all show precision. Specific recording of suicidal thoughts, method, intent and plan shows safety awareness. A closing statement of what the findings support, and what needs rechecking, connects the examination to the assessment. Citations in APA 7 support the approach.
NR 548 Week 3 help: mistakes that cost points
Mental status write-ups most often lose points for adjectives without evidence, such as disheveled, normal or fair. Replace each with what you saw or heard. Another weakness is combining mood and affect, which hides whether they agree. Record them separately. Some students write thought process as normal without saying what it was inferred from. Cognitive findings are often reported as intact with no tasks listed; give the tasks and results. Suicidal ideation must be recorded specifically, including method, intent and plan, not as a single phrase. Avoid interpreting within the observation domains. Keep the write-up organized by domain so a reader can find each quickly, and note any finding that should be rechecked later.
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NR 548 Week 3 questions, answered
Can I ever write within normal limits?
Very rarely here, and only where your section permits it. This assignment exists to build the habit of describing, so rubrics reward described normals directly. The workable habit is to describe every domain in its own terms and let any general statement appear once at the end, if at all, instead of standing in for a domain you did in fact examine.
How do I describe affect without judging it?
Report the range, the reactivity and the quality you observed, then characterize. Restricted range with little change across topics is an observation; flat affect is a characterization that should follow from it. Doing them in that order also protects you when the characterization is arguable, because the reader still has the evidence to disagree with.
What if I could not assess a domain?
Say so where it belongs, with the reason, and move on. Cognition not formally tested owing to time is accurate and marked far better than a silent gap or an invented result. Graders read omissions as either honest or careless depending entirely on whether they are noted, and the note costs one clause.
Where can I find a free NR 548 Week 3 sample paper?
The observation-based mental status write-up is posted above as the NR 548 Week 3 sample, fully readable. If you need one for a different patient, share your notes with us and a write-up in the same style can be drafted.
How should mood and affect be written in NR 548 Week 3?
Mood in the patient's own words, affect described from observation, and a line on whether the two agree. The sample quotes the patient's image of being at the bottom of a hole.