| Course | NRNP 6539 Advanced Primary Care of Adults |
|---|---|
| Week | Week 8 |
| Paper type | Depression screening note |
| Length | About 850 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | October 2026 |
Free sample paper for NRNP 6539 Week 8
Depression Screening at a Preventive Visit: A Positive PHQ-9 Item 9 in a 47-Year-Old Woman and the Suicide Risk Assessment That Followed
Student Name
College of Nursing, Walden University
NRNP 6539: Advanced Nurse Practice in Primary Care Adult Gerontology I
Instructor Name
Month Day, Year
Depression Screening at a Preventive Visit: A Positive PHQ-9 Item 9 in a 47-Year-Old Woman and the Suicide Risk Assessment That Followed
Preventive Visit and the Screen
A.L., a 47-year-old claims adjuster created for this note, came for an annual preventive visit. As part of routine adult depression screening, the two-question screen was administered: over the past two weeks, little interest or pleasure in doing things, "more than half the days" (2 points); feeling down, depressed, or hopeless, "more than half the days" (2 points). A score of 3 or more is positive, so the full PHQ-9 followed (Kroenke et al., 2001).
PHQ-9, item by item: little interest or pleasure, 2; feeling down or hopeless, 2; trouble sleeping, 3 (waking at 4 a.m. nearly every day); tired or little energy, 2; poor appetite, 2; feeling bad about herself or like a failure, 2; trouble concentrating, 2; moving or speaking slowly, 0; item 9, thoughts of self-harm or of being better off dead, 1 (several days). Total: 16, in the moderately severe range. Functional question: symptoms have made work and home life "very difficult."
Item 9 was positive for passive thoughts of being better off dead, which changes the visit: before anything else, the next step is a structured suicide risk assessment.
Suicide Risk Screen
The Columbia-Suicide Severity Rating Scale screener was used, asking each question in plain words (Posner et al., 2011). Wish to be dead, past month: yes; she has thought several times that it would be easier if she did not wake up. Active suicidal thoughts, past month: no. Because question 2 was no, the questions about method, intent, and plan were not required by the screener, but she was asked them anyway for completeness: no method considered, no intent, no plan. Preparatory behavior or attempt, ever: no; she has never made an attempt, started to, or prepared for one, such as collecting pills or writing a note. Past psychiatric history: an episode of depression after her son's birth, treated with therapy.
Protective factors, in her words: "I would never do that to my kids"; "my sister calls me every day"; "I still want to see my son graduate next spring." Risk factors: moderately severe depression, recent bereavement, living alone since her divorce two years ago, and access to medications at home, including leftover opioid tablets from a dental procedure. She does not own a firearm.
Differential Considerations
Bipolar disorder: before starting an antidepressant, the Mood Disorder Questionnaire was completed to screen for past manic or hypomanic episodes (Hirschfeld et al., 2000); she endorsed no periods of elevated mood, decreased need for sleep with high energy, or impulsive behavior, and the screen was negative. Alcohol use: AUDIT-C score of 3, with wine on most evenings since her mother's death; below the threshold for women but increasing, and alcohol worsens depression and lowers inhibition (Bush et al., 1998). Thyroid dysfunction: a thyroid-stimulating hormone is ordered, since hypothyroidism can mimic depression. Recent loss: her mother died four months ago after a long illness she helped manage; grief is expected, but the severity, the functional impairment, and the feelings of worthlessness support major depressive disorder rather than grief alone.
Assessment
Major depressive disorder, single recurrent episode, moderately severe, with passive suicidal ideation without plan, intent, or behavior. On the screener she is at lower acute risk, with strong protective factors, and outpatient management with a safety plan is appropriate. The leftover opioid tablets and her evening drinking are modifiable risk factors addressed below.
Plan
Written safety plan, completed together and given to her on paper: her personal warning signs, such as lying awake at 4 a.m. feeling hopeless; things she can do on her own to cope, such as calling her sister or walking her dog; people and places that help her feel connected; people she can ask for help; professionals and crisis contacts; and steps to make her environment safer (Stanley & Brown, 2012).
Means safety: she agreed to give the leftover opioid tablets to her sister for disposal today and to keep only a week's supply of any new medication at home.
Crisis line information: the 988 Suicide and Crisis Lifeline by call or text, and instructions to go to the emergency department or call 911 if she has thoughts of acting on the wish to be dead.
Warm handoff: the practice's behavioral health clinician met her in the exam room before she left and scheduled a therapy appointment for this week.
Treatment: after discussion, she chose to start an SSRI in addition to therapy; she was told that benefit takes several weeks and that she should report any worsening of mood or new suicidal thoughts, particularly early in treatment. Reduce alcohol, especially in the evenings.
Follow-up: a scheduled phone call from the nurse in three days, and an office visit in two weeks with a repeat PHQ-9. The remaining preventive items from today's visit were completed as planned, and the visit note flags her chart so that any clinician she sees in the next months knows to ask how she is doing and whether the safety plan is still in place.
References
Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158(16), 1789-1795. https://doi.org/10.1001/archinte.158.16.1789
Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Jr., Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J., Russell, J. M., Sachs, G. S., & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875. https://doi.org/10.1176/appi.ajp.157.11.1873
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
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
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
NRNP 6539 Week 8 instructions, in plain terms
The eighth week of NRNP 6539 often asks for a note on mental health screening in primary care. You document the screening process and results, respond to any positive safety item with a structured risk assessment, consider medical and substance causes, and plan treatment, safety measures and follow-up. Faculty judge suicide risk documentation hardest. Cite the USPSTF statements and the validation papers for each tool in APA 7. Medication choice may be left open. A warm handoff or referral pathway should be described. Follow-up timing must be specific. NRNP 6539 faculty want every PHQ-9 item recorded, not just the total. Describe the risk assessment tool and what it found. Name the safety plan's elements and who has a copy. State the follow-up interval in days. Explain the warm handoff to behavioral health.
How the NRNP 6539 Week 8 example is put together
The note begins as a preventive visit and shows the turn. The two-question screen is recorded with its answers, then the full PHQ-9 with each item scored, the total, and the functional question about how hard symptoms have made work and home. Item nine is positive for passive thoughts of being better off dead. The next block documents the Columbia screener question by question, with no plan, no intent, no preparatory behavior, and no past attempt recorded, along with protective factors in her own words. Differential considerations follow: a bipolar screen, alcohol use by AUDIT-C, thyroid function, and a recent loss. The plan records a written safety plan, a conversation about securing medications at home, crisis line information, a warm handoff to the practice's behavioral health clinician, and a scheduled follow-up call.
NRNP 6539 Week 8 rubric: what earns full marks
Suicide risk documentation is where a note like this is judged hardest, and a PHQ-9 total recorded without addressing a positive ninth item is a safety failure that can outweigh everything else in the grade. This example follows the positive item with a named screen and a safety plan. Screening credit depends on showing the instrument at item level and citing the USPSTF recommendation for its central point, that adults be screened for depression, with a positive screen tied to diagnosis, treatment, and follow-up. Diagnostic reasoning is checked through the exclusions; skipping a bipolar screen before discussing antidepressant treatment is a recognized primary care error. Deductions also come from referral written as a phone number handed over, from follow-up with no date, and from stigmatizing language anywhere in the record.
NRNP 6539 Week 8 help from the desk
Depression notes are judged most harshly when a PHQ-9 total is recorded without addressing a positive ninth item. Always document the risk assessment that follows. Another common gap is skipping medical causes such as hypothyroidism or alcohol use. Screen for them. Writers also leave out a safety plan or describe it vaguely. List its parts. Avoid choosing an antidepressant before risk is assessed. Show every PHQ-9 item. Explain the warm handoff. Close with follow-up within a set number of days. Students also forget access to lethal means, such as firearms or stored medications. Ask and plan. Another frequent gap is no mention of crisis resources such as the 988 line. Add them. Writers sometimes treat passive thoughts as low risk without reassessment. Plan to reassess. Close with who will call her and when.
Get a NRNP 6539 Week 8 example written to your instructions
Send the Week 8 prompt, the rubric, and the screening case your section set, depression, anxiety, or substance use. The note returned reports each instrument at item level, puts safety ahead of treatment, and records referral as a handoff with a date. No charge applies to a first custom sample; expect it within 24-48 hours.
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NRNP 6539 Week 8 questions, answered
Why show every PHQ-9 item instead of the total?
Because the total measures severity while individual items carry information the total hides, most importantly the ninth, which asks about thoughts of death or self-harm. A moderate total with a positive ninth item calls for a different response than the same total without it. The example lists all nine answers so a grader can see the author noticed which one mattered.
Does the note choose an antidepressant?
It records that treatment options were discussed, psychotherapy referral and medication by class, and that the decision was shared, but it stays focused on screening, safety, and follow-up and does not argue drug mechanisms or dosing. Some sections want a specific agent with rationale; a sample written to such a rubric supplies one, with the bipolar screen result recorded beside it first.
What is a warm handoff?
A referral made in person, or by live introduction, to a behavioral health clinician working in or alongside the practice, rather than a name and number given to the patient to call later. It is a feature of integrated and collaborative care models. The example records who received her, when, and what was agreed, because graders look for referral that can be verified.
Where can I find a free NRNP 6539 Week 8 sample paper?
A.L.'s screening note is reproduced here with every PHQ-9 item, the Columbia suicide risk assessment, the differential and the safety plan.
What should happen after a positive PHQ-9 item 9 in NRNP 6539 Week 8?
A structured suicide risk assessment the same visit. The example uses the Columbia scale, builds a safety plan and arranges a warm handoff to behavioral health.