NRNP 6540 Week 2 Memory Complaint Note Example

Course	NRNP 6540 Advanced Practice Care of Older Adults
Week	Week 2
Paper type	Evaluation note
Length	About 770 words, 5 pages
Format	APA 7 student paper
School	Walden University
Program	Master of Science in Nursing (MSN)
Updated	October 2026

Free sample paper for NRNP 6540 Week 2

Memory Complaint Evaluation Note: A 76-Year-Old Retired Accountant, His Wife's Account, and a Bladder Medication

Student Name

College of Nursing, Walden University

NRNP 6540: Advanced Nurse Practice in Primary Care Adult Gerontology II

Instructor Name

Month Day, Year

What this page is doingThe title names three sources of evidence: the patient, his wife, and his medication list. A memory evaluation that relied on one of them would miss what the others show, and the bladder medication is the finding that keeps the note from committing to a diagnosis too early.

Memory Complaint Evaluation Note: A 76-Year-Old Retired Accountant, His Wife's Account, and a Bladder Medication

History From Two Sources

The patient is a composite: a 76-year-old retired accountant who comes with his wife because she is worried about his memory.

What he reports: he forgets names more than he used to and sometimes walks into a room and forgets why; he thinks this is normal for his age. He still pays the bills and does the taxes, he says. He denies getting lost while driving.

What his wife reports, dated where she could: about eight months ago he paid the electric bill twice in one month and missed the water bill entirely, which had never happened in 50 years; in the spring he left a pot on the stove and the smoke alarm went off; last month he could not find his way back from a new grocery store and called her from the parking lot; he repeats questions within the same conversation. She now reviews the checkbook after him. She has not noticed personality change, hallucinations, or falls.

The instrumental tasks, the bills and the stove, carry more weight than recall of a word list, because they are what his independence depends on and because his own account underestimates them. Other history: overactive bladder treated with oxybutynin 5 mg three times daily, started by a urologist nine months ago; hypertension; hyperlipidemia. No head injury, alcohol excess, or stroke. His mood has been "a bit flat" since he retired, his wife says.

Objective

Montreal Cognitive Assessment, reported by domain rather than by total (Nasreddine et al., 2005): visuospatial and executive, 2 of 5 (trail-making and clock drawing impaired, cube copied correctly); naming, 3 of 3; attention, 5 of 6; language, 2 of 3; abstraction, 2 of 2; delayed recall, 1 of 5, improving to 3 of 5 with category cues; orientation, 6 of 6. Total 21 of 30, with one point added for education already reflected. The pattern is weakest in delayed recall and executive items.

Hearing: whispered voice test normal bilaterally. Depression: Geriatric Depression Scale short form 4 of 15, below the usual cut-off. Neurologic examination: no focal deficits, normal gait, no tremor or rigidity. Blood pressure 132/78 seated without orthostatic drop.

Medication list: oxybutynin, amlodipine, atorvastatin, a daily multivitamin. Oxybutynin is strongly anticholinergic and crosses into the brain, and the American Geriatrics Society advises avoiding strongly anticholinergic drugs in older adults, particularly those with cognitive impairment (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023).

Laboratory: thyroid-stimulating hormone and vitamin B12 ordered; complete blood count and metabolic panel from last month normal.

Differential

Mild cognitive impairment: supported by a decline from his previous level noticed by him and his wife, objective impairment on testing, and preserved basic function, although the bill and stove episodes suggest some instrumental decline (Petersen, 2016).

Early Alzheimer-type dementia: supported by prominent delayed recall impairment, repeated questions, getting lost in a new place, and loss of a complex instrumental task. Cued recall improving his score suggests a retrieval component, which can be seen in several conditions.

Medication effect: oxybutynin started nine months ago, close to when his wife first noticed the bill problem. Anticholinergic drugs can impair memory and attention, and the effect is reversible.

Depression: flat mood since retirement, but a negative depression screen.

Vascular cognitive impairment: vascular risk factors and executive weakness, but no stroke history or focal signs.

The note declines to commit to a diagnosis until the anticholinergic drug has been dealt with, because any score obtained while he is taking it may overstate his impairment.

Plan and Safety

Medication: stop oxybutynin after discussion with him and his urologist; manage overactive bladder with timed voiding and fluid timing, and if medication is needed, consider mirabegron, which lacks anticholinergic effects. Repeat the Montreal Cognitive Assessment in about three months after the drug has cleared, using an alternate version to reduce practice effect.

Laboratory results reviewed at follow-up; brain imaging considered if decline continues after the medication change.

Safety: his wife will continue to oversee finances; an automatic shut-off device for the stove was discussed; driving was addressed directly, and given the episode of getting lost, he agreed to drive only familiar local routes during the day until reassessment, with a formal driving evaluation offered.

What they were told: that his testing shows real changes in memory and planning, that one of his medicines may be contributing and will be stopped first, and that the picture will be clearer after it has cleared. His wife was thanked for her detailed account, which shaped the evaluation. Follow-up: three months, with both present.

References

2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372

Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x

Petersen, R. C. (2016). Mild cognitive impairment. Continuum: Lifelong Learning in Neurology, 22(2), 404-418. https://doi.org/10.1212/CON.0000000000000313

NRNP 6540 Week 2 instructions, in plain terms

In Week 2, NRNP 6540 often presents an older adult with a memory complaint and asks for an evaluation note. You take the history twice, from the patient and from someone who knows him well, administer a cognitive screen, check for depression and reversible causes, review medications, form a differential, and plan next steps including safety. Faculty penalize jumping from a screening score to a diagnosis. Cite screening instrument validation, the Beers Criteria and dementia evaluation guidance in APA 7. Driving, finances and home safety commonly belong in the plan. Some sections ask for a follow-up interval and referral criteria. Respect for the patient's dignity during the history is part of the grade. NRNP 6540 faculty also want the informant's account recorded separately so the two views can be compared.

How this NRNP 6540 Week 2 example is built

The history is written in two columns: what he reports and what his wife reports, each dated where possible. Instrumental tasks are the center of it, because the bills and the stove matter more than recall of a word list. The Montreal Cognitive Assessment is reported by domain rather than by total, showing delayed recall and executive items weakest. A hearing screen, a depression screen, and the medication list follow, and the list turns up a bladder medication with strong anticholinergic effects. Labs for thyroid function and vitamin B12 are recorded as ordered. The differential weighs mild cognitive impairment, early Alzheimer-type dementia, medication effect, depression, and vascular change, and it declines to commit until the drug has been dealt with. A safety block covers driving, the stove, and finances.

NRNP 6540 Week 2 rubric: what earns full marks

Premature labeling is the error memory evaluations are penalized for most heavily: moving from a low screening score to a dementia diagnosis in one step skips the reasoning the week is examining. This example holds its differential open until the anticholinergic drug is addressed and re-testing is done. Credit for data collection depends on the collateral history; notes built on the patient's account alone tend to lose points however detailed they are. The AGS Beers Criteria are expected on the medication list, since a strongly anticholinergic drug in an older adult with memory complaints is exactly the kind of prescription the criteria exist to flag. Missing safety content costs as well, particularly on driving, and so does a plan with no re-evaluation date.

Common NRNP 6540 Week 2 mistakes, and how to avoid them

Memory notes lose the most when a low screening score is written up as dementia. A screen raises a question; it does not answer it. Another common gap is skipping the medication review, though anticholinergic drugs such as some bladder medications can impair memory. Writers also leave out depression and delirium, both treatable. Screen for them. Avoid discussing the patient as if he were not in the room. Record the wife's account as evidence while noting it is one view. Laboratory tests such as B12 and thyroid function should appear with a reason. Close with a recheck date after the medication change. Another frequent slip is ignoring hearing and vision, which can lower a cognitive screen score on their own. Check them before the screen.

Get a NRNP 6540 Week 2 example written to your instructions

Send the Week 2 prompt and rubric, along with the case and any screening results your section provides. The evaluation note that comes back weighs both informants, clears reversible causes before naming anything, and addresses safety. Collateral history is drawn from whichever informant your case provides. Free as your first custom sample, and delivered within 24-48 hours.

More NRNP 6540 papers and MSN samples

NRNP 6540 Week 2 questions, answered

Why not diagnose dementia from the screening score?

Because a screen identifies who needs further evaluation; it does not make the diagnosis. Hearing loss, depression, and medication effects can all lower a score, and the example rules those in or out first. Rubrics in older-adult courses tend to penalize a label applied on a single result, and they reward an explicitly provisional differential with its next step named.

What cognitive screen appears in the note?

The note reports the Montreal Cognitive Assessment by domain, and it names the Mini-Cog as an alternative for a brief first pass. Courses differ in which instrument they teach, and some sections supply results in the case itself. When yours does, the sample interprets those results in place of the example's, keeping the domain-level reporting intact.

How much of the note belongs to the wife's account?

Roughly as much as belongs to his. In a memory evaluation the person closest to daily life often sees changes the patient does not, and the example gives her observations equal space and dates. It also records where the two accounts agree, which can be as informative as where they differ. A missing collateral history is a gap graders note often.

Where can I find a free NRNP 6540 Week 2 sample paper?

The memory complaint note is shown here with both accounts, the screening results, the differential and the plan that stops the bladder medication first.

Whose account matters in NRNP 6540 Week 2?

Both the patient's and his wife's, whose report of missed bills and repeated questions carries real weight in the history.