course materials

1. NURS 6630N Week 7: Therapy for Patients With Schizophrenia
NURS 6630N Week 7: Therapy for Patients With SchizophreniaNURS 6630N Week 7:
Therapy for Patients With SchizophreniaPermalink: https:// /nurs-6630n-week-…th-
schizophrenia/According to the Schizophrenia and Related Disorders Alliance of America,
approximately 3.5 million people in the United States are diagnosed with schizophrenia
(n.d.), and it is one of the leading causes of disability. In practice, patients may present with
delusions, hallucinations, disorganized thinking, disorganized or abnormal motor behavior,
as well as other negative symptoms that can be disabling for these individuals. Not only are
these symptoms one of the most challenging symptom clusters you will encounter, many
are associated with other disorders, such as depression, bipolar disorder, and disorders on
the schizophrenia spectrum. As a psychiatric nurse practitioner, you must understand the
underlying neurobiology of these symptoms to select appropriate therapies and improve
outcomes for patients.This week, as you examine antipsychotic therapies, you explore the
assessment and treatment of patients with psychosis and schizophrenia. You also consider
ethical and legal implications of these therapies.Reference:Schizophrenia and Related
Disorders Alliance of America.
(n.d.). About schizophrenia.https://sardaa.org/resources/about-
schizophrenia/#:~:text=Quick%20Facts%20About%20Schizophrenia.%20Schizophrenia%
20can%20be%20found,is%20one%20of%20the%20leading%20causes%20of%20disabilit
yLearning ObjectivesStudents will:Assess client factors and history to develop personalized
therapy plans for patients with insomniaAnalyze factors that influence pharmacokinetic and
pharmacodynamic processes in patients requiring therapy for insomniaAssess patient
factors and history to develop personalized plans of antipsychotic therapy for
patientsAnalyze factors that influence pharmacokinetic and pharmacodynamic processes in
patients requiring antipsychotic therapySynthesize knowledge of providing care to patients
presenting for antipsychotic therapyAnalyze ethical and legal implications related to
prescribing antipsychotic therapy to patients across the lifespanLearning Resources (NURS
6630N Week 7: Therapy for Patients With Schizophrenia)Required Readings (click to
expand/reduce)Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs.
In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General
Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.American
Psychiatric Association. (2019). Practice guideline for the treatment of patients with
schizophrenia.
https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice

2. %20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdfClozapine REMS. (2015).
Clozapine REMS: The single shared system for clozapine.
https://www.clozapinerems.com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS
_A_Guide_for_Healthcare_Providers.pdfFunk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M.,
Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J.
(2018). Resource document on QTc prolongation and psychotropic medications. American
Psychiatric Association.
https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-
Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-
Psychotropic-Med.pdfKay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative
Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261–
276. https://doi.org/10.1093/schbul/13.2.261Levenson, J. C., Kay, D. B., & Buysse, D. J.
(2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/McClellan, J. & Stock. S. (2013).
Practice parameter for the assessment and treatment of children and adolescents with
schizophrenia. Journal of the American Academy of Child and Adolescent Psychiatry, 52(9),
976–990. https://www.jaacap.org/article/S0890-8567(09)62600-9/pdfNaber, D., &
Lambert, M. (2009). The CATIE and CUtLASS studies in schizophrenia: Results and
implications for clinicians. CNS Drugs, 23(8), 649–659. https://doi.org/10.2165/00023210-
200923080-00002Medication Resources (click to expand/reduce)IBM Corporation. (2020).
IBM Micromedex.
https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=d
eepLink&institution=SZMC%5ESZMC%5ET43537Note: To access the following
medications, use the IBM Micromedex resource. Type the name of each medication in the
keyword search bar. Be sure to read all sections on the left navigation bar related to each
medication’s result page, as this information will be helpful for your review in preparation
for your
Assignments. amisulpridearipiprazoleasenapinebrexpiprazolecariprazinechlorpromazinecl
ozapineflupenthixolfluphenazinehaloperidoliloperidoneloxapinelumateperonelurasidoneol
anzapinepaliperidoneperphenazinepimavanserinquetiapinerisperidonesulpiridethioridazin
ethiothixenetrifluoperazineziprasidone Required Media (click to expand/reduce)Case
study: Pakistani woman with delusional thought processesNote: This case study will serve
as the foundation for this week’s Assignment.Optional Resources (click to
expand/reduce)Chakos, M., Patel, J. K., Rosenheck, R., Glick, I. D., Hammer, M. B., Tapp, A.,
Miller, A. L., & Miller, D. D. (2011). Concomitant psychotropic medication use during
treatment of schizophrenia patients: Longitudinal results from the CATIE study. Clinical
Schizophrenia & Related Psychoses, 5(3), 124–134.
https://doi.org/10.3371/CSRP.5.3.2Fangfang, S., Stock, E. M., Copeland, L. A., Zeber, J. E.,
Ahmedani, B. K., & Morissette, S. B. (2014). Polypharmacy with antipsychotic drugs in
patients with schizophrenia: Trends in multiple health care systems. American Journal of
Health-System Pharmacy, 71(9), 728–738. https://doi.org/10.2146/ajhp130471Lin, L. A.,
Rosenheck, R., Sugar, C., & Zbrozek, A. (2015). Comparing antipsychotic treatments for
schizophrenia: A health state approach. The Psychiatric Quarterly, 86(1), 107–121.

3. https://doi.org/10.1007/s11126-014-9326-2Discussion: Treatment for a Patient With a
Common ConditionInsomnia is one of the most common medical conditions you will
encounter as a PNP. Insomnia is a common symptom of many mental illnesses, including
anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have
demonstrated the bidirectional relationship between insomnia and mental illness. In fact,
about 50% of adults with insomnia have a mental health problem, while up to 90% of adults
with depression experience sleep problems (Abbott, 2016). Due to the interconnected
psychopathology, it is important that you, as the PNP, understand the importance of the
effects some psychopharmacologic treatments may have on a patient’s mental health illness
and their sleep patterns. Therefore, it is important that you understand and reflect on the
evidence-based research in developing treatment plans to recommend proper sleep
practices to your patients as well as recommend appropriate psychopharmacologic
treatments for optimal health and well-being. NURS 6630N Week 7: Therapy for Patients
With SchizophreniaReference: Abbott, J. (2016). What’s the link between insomnia and
mental illness? Health. https://www.sciencealert.com/what-exactly-is-the-link-between-
insomnia-and-mental-
illness#:~:text=Sleep%20problems%20such%20as%20insomnia%20are%20a%20commo
n,bipolar%20disorder%2C%20and%20attention%20deficit%20hyperactivity%20disorder
%20%28ADHD%29For this Discussion, review the case Learning Resources and the case
study excerpt presented. Reflect on the case study excerpt and consider the therapy
approaches you might take to assess, diagnose, and treat the patient’s health needs.Case: An
elderly widow who just lost her spouse. Subjective: A patient presents to your primary care
office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and
MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her
depression has gotten worse as well as her sleep habits. The patient has no previous history
of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient
normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient
arrived at the office today by private vehicle. Patient currently takes the following
medications: Metformin 500mg BID Januvia 100mg daily Losartan 100mg daily HCTZ 25mg
daily Sertraline 100mg daily Current weight: 88 kgCurrent height: 64 inchesTemp: 98.6
degrees FBP: 132/86 By Day 3 of Week 7Post a response to each of the following:List three
questions you might ask the patient if she were in your office. Provide a rationale for why
you might ask these questions.Identify people in the patient’s life you would need to speak
to or get feedback from to further assess the patient’s situation. Include specific questions
you might ask these people and why.Explain what, if any, physical exams, and diagnostic
tests would be appropriate for the patient and how the results would be used.List a
differential diagnosis for the patient. Identify the one that you think is most likely and
explain why.List two pharmacologic agents and their dosing that would be appropriate for
the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics.
From a mechanism of action perspective, provide a rationale for why you might choose one
agent over the other.For the drug therapy you select, identify any contraindications to use
or alterations in dosing that may need to be considered based on ethical prescribing or
decision-making. Discuss why the contraindication/alteration you identify exists. That is,

4. what would be problematic with the use of this drug in individuals based on ethical
prescribing guidelines or decision-making?Include any “check points” (i.e., follow-up data at
Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on
possible outcomes that may happen given your treatment options chosen.Read a selection
of your colleagues’ responses.Sample Discussion ApproachManagement of insomnia can be
complex for many patients. Some of the main factors causing insomnia may include
increased caffeine consumption, stressful events, work schedule, or medication. 75 -year-
old female presents at the office with worsening signs of depression and new onset of
insomnia. There are many types of insomnia. Some patients may have problems falling
asleep, some have difficulty maintaining sleep, and some report waking up feeling tired, not
refreshed. All those problems can be generalized as insomnia; however, they are treated
differently. The physical exam of this patient is WNL, and the mental exam confirms that
patient is not suicidal. This patient is also already treated with 100 mg Sertraline for MDD.
My three questions would address the patient’s concerns during the visit.Do you have
problems with falling asleep or maintaining sleep? When you wake up in the morning, do
you feel well-rested?Identifying the type of insomnia is critical since some of the factors
contributing to insomnia may be resolved without hypnotics. Current formal diagnoses of
insomnia now rely more upon perceptions of sleep quality, duration, and daytime
functioning than upon strictly objective physiological (EEG) measures (Monk et al., 2008). If
hypnotics are indicated, we have to choose the right drug that will address the problem. We
have many hypnotic medicines that may induce sleep (like Halcion, Edluar, Rozerem),
maintain sleep (Flurazepam, Estazolam, Restoril), or have a dual-action (Ambien, Lunesta,
Belsmora). Each hypnotic works differently and has different potential side effects that may
affect this 75-year-old patient.I would ask questions about medication management
(including SSRI and diuretics). How is she taking her medication? Is she taking Zoloft in AM
or at night?Some of the drugs, including SSRIs/SNRI’s like Zoloft, may cause insomnia.
Taking a diuretic may also disturb sleep patterns if she is taking it at night. One of the most
common complaints from patients taking diuretics is that they have to get up in the middle
of the night to use the bathroom.Do you feel hopeless? Do you feel like nothing matters to
you?Evaluating the efficacy of existing antidepressants is critical in treatment. Is the
dose/drug sufficient? When was the last time it was adjusted? That information will help
me make the decision if the existing therapy has to be augmented with a second
medication? NURS 6630N Week 7: Therapy for Patients With
Schizophrenia Evaluating the new socioeconomic and demographic situation this
patient is in is critical in this case. Therefore, the main questions I would have asked the
patient’s direct support (family, friends) and indirect support (neighbors, counselors)
would address her new socioeconomic situation, life adjustments, and coping mechanism.
The family and friends would provide me with more information about the new situation
the patient is in, her coping mechanism, and potential needs. Indirect support can also
contribute to assessment with additional information about ADL’s and socioeconomic
conditions. The questions I would have asked:How is she coping with the tragedy? Who is
her most prominent support person? Does she have a grieving counselor?This risk of
depression appears to peak during the first twelve months of bereavement, although

5. worsening depressive symptoms can be present for up to 2 years (Monk et al., 2008).
Therefore, identifying a close support group or grieving counselor has beneficial effects on
mental status after losing a loved one.How is she adjusting to new situations? Is she alone at
home? Does she need daily support?Lack of daytime stimulation, companionship, frequent
“power naps,” excessive caffeine consumption, and an unhealthy diet can contribute to
insomnia and MDD. Can she drive? How is she getting her groceries, medication, or
meals?Apart from the severe emotional strain of losing a loved one, there are profound
changes in lifestyle and status, often accompanied by reductions in financial security,
perceived personal safety, and freedom of action (Monk et al., 2008). Some elderly patients
do not drive due to neuromuscular or vision changes, and they entirely depend on their
spouses. They may be some needs in basic needs like getting groceries, picking up her
prescriptions or dropping her off for a medical appointment. These limitations and
excessive worrying about new dependent positions can contribute to MDD and
insomnia. The diagnostic exam would include essential medical work op: EKG, CBC,
CMP, AC1. Ordering a basic panel can give me a better idea of the patient’s overall health
condition and potential electrolyte imbalance that may be causing insomnia. The second
assessment would include the mental exam. PMHNP can use multiple tools to evaluate a
patient with depression. Some of the tools I would use are the Montgomery-Asberg
Depression Rating Scale (MADRS) to measure the severity of depression or the Geriatric
Depression Short Scale Form (SGDS). To evaluate insomnia, we can use Pittsburgh Sleep
Quality Index to assess the severity and type of insomnia.Three Differential diagnoses
include:MDDInsomnia – chronic sleep disturbanceMelancholia – is a subtype of MDD, and it
is characterized by anhedonia, depression, lack of mood reactivity, and sleep disturbance.
Sleep disturbance may lead to early morning awakening, mental
decompensation. Sleep disturbance and depression are common in bereaved
individuals and may lead to poor physical and mental health outcomes (Nutt et al., 2008).
The recommended treatment for this patient is psychosocial therapy (CBT),
antidepressants, and medication to treat insomnia. Based on the evaluation, few options are
available for this patient. We can continue SSRI and add short-acting benzodiazepine or
hypnotic. Although anxiolytics and hypnotics will not address worsening depression. My
main goal is to address both insomnia and depression. This patient is currently on Zoloft
100 mg QD. Therefore I would recommend:Cognitive Behavioral Therapy or Grieve
Counseling session for this patient; Continue Zoloft 100mg QD;Add the second
antidepressant with hypnotic properties like Trazadone 150 mg QHS;Trazadone is an
antidepressant that can decrease sleep latency and prolong sleep duration. It is frequently
used in treating depression and SSRI/SRNI induced insomnia. Trazadone is one of the very
few drugs to prevent drug dependency insomnia. Trazadone may be a great adjunct, but the
patient has to be observed for residual CNS depression that sometimes may persist the next
day and orthostatic hypotension (alpha-adrenergic blockage). Fall risk assessment and
general physicals should be completed before therapy. The patient should be instructed to
slowly change the position and take medicines with small snacks to increase absorption.
Zoloft and Trazadone treatment can be beneficial, but the patient must also be observed for
dangerous serotonin syndrome that can be minimized by keeping this patient at the

6. minimal dose of Trazadone. My second option was to augment Zoloft with Doxepin (TCA)
that blocks histamine receptors. Doxepin can increase total sleep time and maintain the
effect for more than 12 weeks. Although, TCA’s increases the chances of developing more
severe orthostatic hypotension, sedation, anticholinergic effect (constipation, urinary
retention, blurry vision) in the elderly. Those adverse effects put this patient at higher risk
for falls and treatment non-adherence PMHNP should also consider drug interactions
when treating patients with multiple medical problems.This patient is currently taking
Metformin, Zoloft, HCTZ, Januvia, and Losartan. Adding Trazadone may have an additive
effect on BP and induce hypotension/orthostatic hypotension; therfore Losartan’s dose may
have to be adjusted in the future. Additionally, SSRI’s in combination with
hypoglycemic like Metformin makes managing glucose level more difficult for the patient.
Frequent glucose monitoring is recommended. SSRI and Trazadone have to be watched for
dangerous serotonin syndrome. In prescribing a second antidepressant, we have to
consider renal, liver function, and drug-to-drug interaction, especially Trazadone and Zoloft.
The medications should be kept at a low dose and titrated carefully to avoid unwanted
complications. The dose should be started adjusted based on renal/liver function. I
initially thought about augmenting Zoloft just with simple Melatonin to improve sleep
habits, but Melatonin would not address depression. Also, benzodiazepines like Temazepam
can help a short period, but it has no efficacy in depression treatment, increases drug
dependency, and falls risk. Therefore, my recommendation is to initiate psychosocial
therapy, continue Zoloft, add a low dose of Trazadone to alleviate depression, and treat
insomnia without inducing serious adverse effects. NURS 6630N Week 7: Therapy for
Patients With Schizophrenia The patient has to be re-evaluated in 4 weeks for signs
and symptoms of serotonin syndrome, orthostatic hypotension, and excessive sedation.
PMHNP should provide a new assessment questionnaire for depression/insomnia, and
based on the results the therapy should be adjusted.ReferencesMonk, T. H., Germain, A., &
Reynolds, C. F. (2008). Sleep Disturbance in Bereavement. Psychiatric Annals, 38(10), 671–
675. https://doi.org/10.3928/00485713-20081001-06Montgomery, S.A., & Åsberg, M.
(1979). A new depression scale designed to be sensitive to change. The British Journal of
Psychiatry, 134, 382-389. http://dx.doi.org/10.1192/bjp.134.4.382Nutt, D., Wilson, S., &
Paterson, L. (2008). Sleep disorders as core symptoms of depression. Dialogues in clinical
neuroscience, 10(3), 329–336. https://doi.org/10.31887/DCNS.2008.10.3/dnutTroxel WM,
Kupfer DJ, Reynolds CF 3rd, Frank E, Thase ME, Miewald JM, Buysse DJ. Insomnia and
objectively measured sleep disturbances predict treatment outcome in depressed patients
treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J ClinBy Day
6 of Week 7Respond to at least two of your colleagues on two different days in one of the
following ways:If your colleagues’ posts influenced your understanding of these concepts,
be sure to share how and why. Include additional insights you gained.If you think your
colleagues might have misunderstood these concepts, offer your alternative perspective and
be sure to provide an explanation for them. Include resources to support your
perspective.Read a selection of your colleagues’ responses and respond to at least two of
your colleagues on two different days andNote: For this Discussion, you are required to
complete your initial post before you will be able to view and respond to your colleagues’

7. postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create
Thread” to complete your initial post. Remember, once you click on Submit, you cannot
delete or edit your own posts, and you cannot post anonymously. Please check your post
carefully before clicking on Submit! NURS 6630N Week 7: Therapy for Patients With
SchizophreniaSubmission and Grading InformationGrading CriteriaTo access your
rubric:Week 7 Discussion RubricPost by Day 3 of Week 7 and Respond by Day 6 of Week
7To Participate in this Discussion:Week 7 DiscussionAssignment: Assessing and Treating
Patients With Psychosis and SchizophreniaPsychosis and schizophrenia greatly impact the
brain’s normal processes, which interfere with the ability to think clearly. When symptoms
of these disorders are uncontrolled, patients may struggle to function in daily life. However,
patients often thrive when properly diagnosed and treated under the close supervision of a
psychiatric mental health practitioner. For this Assignment, as you examine the patient case
study in this week’s Learning Resources, consider how you might assess and treat patients
presenting with psychosis and schizophrenia.To prepare for this Assignment:Review this
week’s Learning Resources, including the Medication Resources indicated for this
week.Reflect on the psychopharmacologic treatments you might recommend for the
assessment and treatment of patients with schizophrenia-related psychoses.The
Assignment: 5 pagesExamine Case Study: Pakistani Woman With Delusional Thought
Processes. You will be asked to make three decisions concerning the medication to
prescribe to this patient. Be sure to consider factors that might impact the patient’s
pharmacokinetic and pharmacodynamic processes.At each decision point, you should
evaluate all options before selecting your decision and moving throughout the exercise.
Before you make your decision, make sure that you have researched each option and that
you evaluate the decision that you will select. Be sure to research each option using the
primary literature.Introduction to the case (1 page)Briefly explain and summarize the case
for this Assignment. Be sure to include the specific patient factors that may impact your
decision making when prescribing medication for this patient.Decision #1 (1 page)Which
decision did you select?Why did you select this decision? Be specific and support your
response with clinically relevant and patient-specific resources, including the primary
literature.Why did you not select the other two options provided in the exercise? Be specific
and support your response with clinically relevant and patient-specific resources, including
the primary literature.What were you hoping to achieve by making this decision? Support
your response with evidence and references to the Learning Resources (including the
primary literature).Explain how ethical considerations may impact your treatment plan and
communication with patients. Be specific and provide examples.Decision #2 (1 page)Why
did you select this decision? Be specific and support your response with clinically relevant
and patient-specific resources, including the primary literature.Why did you not select the
other two options provided in the exercise? Be specific and support your response with
clinically relevant and patient-specific resources, including the primary literature.What
were you hoping to achieve by making this decision? Support your response with evidence
and references to the Learning Resources (including the primary literature).Explain how
ethical considerations may impact your treatment plan and communication with patients.
Be specific and provide examples. NURS 6630N Week 7: Therapy for Patients With

8. SchizophreniaDecision #3 (1 page)Why did you select this decision? Be specific and support
your response with clinically relevant and patient-specific resources, including the primary
literature.Why did you not select the other two options provided in the exercise? Be specific
and support your response with clinically relevant and patient-specific resources, including
the primary literature.What were you hoping to achieve by making this decision? Support
your response with evidence and references to the Learning Resources (including the
primary literature).Explain how ethical considerations may impact your treatment plan and
communication with patients. Be specific and provide examples.Conclusion (1
page)Summarize your recommendations on the treatment options you selected for this
patient. Be sure to justify your recommendations and support your response with clinically
relevant and patient-specific resources, including the primary literature.Note: Support your
rationale with a minimum of five academic resources. While you may use the course text to
support your rationale, it will not count toward the resource requirement. You should be
utilizing the primary and secondary literature.Reminder : The College of Nursing requires
that all papers submitted include a title page, introduction, summary, and references. The
Sample Paper provided at the Walden Writing Center provides an example of those
required elements (available at
https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-
20293632). All papers submitted must use this formatting.By Day 7Submit your
Assignment.Submission and Grading InformationTo submit your completed Assignment for
review and grading, do the following:Please save your Assignment using the naming
convention “WK7Assgn+last name+first initial.(extension)” as the name.Click the Week 7
Assignment Rubric to review the Grading Criteria for the Assignment.Click the Week 7
Assignment link. You will also be able to “View Rubric” for grading criteria from this
area.Next, from the Attach File area, click on the Browse My Computer button. Find the
document you saved as “WK7Assgn+last name+first initial.(extension)” and click Open.If
applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my
paper(s) to the Global Reference Database. NURS 6630N Week 7: Therapy for Patients With
SchizophreniaClick on the Submit button to complete your submission.Grading CriteriaTo
access your rubric:Week 7 Assignment RubricCheck Your Assignment Draft for
AuthenticityTo check your Assignment draft for authenticity:Submit your Week 7
Assignment draft and review the originality report.Submit Your Assignment by Day 7 of
Week 7To participate in this Assignment:Week 7 AssignmentRubric Detail – NURS 6630N
Week 7: Therapy for Patients With SchizophreniaSelect Grid View or List View to change
the rubric’s layout.Name: NURS_6630_Week7_Assignment_RubricGrid ViewList
ViewExcellentPoint range: 90–100GoodPoint range: 80–89FairPoint range: 70–79PoorPoint
range: 0–69Introduction to the case (1 page)Briefly explain and summarize the case for this
Assignment. Be sure to include the specific patient factors that may impact your decision
making when prescribing medication for this patient.9 (9%) – 10 (10%)The response
accurately, clearly, and fully summarizes in detail the case for the Assignment.The response
accurately and clearly explains in detail the specific patient factors that impact decision
making when prescribing medication for this patient.8 (8%) – 8 (8%)The response
accurately summarizes the case for the Assignment.The response accurately explains the

9. specific patient factors that impact decision making with prescribing medication for this
patient.7 (7%) – 7 (7%)The response inaccurately or vaguely summarizes the case for the
Assignment.The response inaccurately or vaguely explains the specific patient factors that
impact decision making with prescribing medication for this patient.0 (0%) – 6 (6%)The
response inaccurately and vaguely summarizes the case for the Assignment, or is
missing.The response inaccurately and vaguely explains the specific patient factors that
impact decision making with prescribing medication for this patient.Decision #1 (1–2
pages)• Which decision did you select?• Why did you select this decision? Be specific and
support your response with clinically relevant and patient-specific resources, including the
primary literature.• Why did you not select the other two options provided in the exercise?
Be specific and support your response with clinically relevant and patient-specific
resources, including the primary literature.• What were you hoping to achieve by making
this decision? Support your response with evidence and references to the Learning
Resources (including the primary literature).• Explain how ethical considerations may
impact your treatment plan and communication with patients. Be specific and provide
examples.18 (18%) – 20 (20%)The response accurately and clearly explains in detail the
decision selected.The response accurately and clearly explains in detail why the decision
was selected, with specific clinically relevant resources that fully support the decision
selected.The response accurately and clearly explains in detail why the other two responses
were not selected, with specific clinically relevant resources that fully support the
response.The response accurately and clearly explains in detail the outcome the student
was hoping to achieve with the selected decision, with specific clinically relevant resources
that fully support the response.The response accurately and clearly explains in detail how
ethical considerations impact the treatment plan and communication with
patients.Examples provided fully support the decisions and responses provided.16 (16%) –
17 (17%)The response accurately explains the decision selected.The response explains why
the decision was selected, with specific clinically relevant resources that support the
decision selected.The response accurately explains why the other two responses were not
selected, with specific clinically relevant resources that support the response.The response
accurately explains the outcome the student was hoping to achieve with the selected
decision, with specific clinically relevant resources that support the response.The response
accurately explains how ethical considerations impact the treatment plan and
communication with patients.Examples provided support the decisions and responses
provided. NURS 6630N Week 7: Therapy for Patients With Schizophrenia14 (14%) –
15 (15%)The response inaccurately or vaguely explains the decision selected.The response
inaccurately or vaguely explains why the decision was selected, with specific clinically
relevant resources that inaccurately or vaguely support the decision selected.The response
inaccurately or vaguely explains why the other two responses were not selected, with
specific clinically relevant resources that inaccurately or vaguely support the response.The
response inaccurately or vaguely explains the outcome the student was hoping to achieve
with the selected decision, with specific clinically relevant resources that inaccurately or
vaguely support the response.The response inaccurately or vaguely explains how ethical
considerations impact the treatment plan and communication with patients.Examples

10. provided may support the decisions and responses provided.0 (0%) – 13 (13%)The
response inaccurately and vaguely explains the decision selected.The response inaccurately
and vaguely explains why the decision was selected, with specific clinically relevant
resources that do not support the decision selected, or is missing.The response inaccurately
and vaguely explains why the other two responses were not selected, with specific clinically
relevant resources that do not support the decision selected, or is missing.The response
inaccurately and vaguely explains the outcome the studen