NU 671 Unit 4 Medical Mimic Exclusion Log Example

Course	NU 671 Clinical Decision-Making in Psychiatric Mental Health
Unit	Unit 4
Paper type	Medical mimic exclusion log
Length	About 540 words, 4 pages
Format	APA 7 student paper
School	Herzing University
Program	MSN Psychiatric Mental Health Nurse Practitioner
Updated	October 2026

Free sample paper for NU 671 Unit 4

Medical Mimic Exclusion Log for Mr. K.: What Was Done, What It Returned, and Which Questions Remain Open

Student Name

Department of Nursing, Herzing University

NU 671: Clinical Decision-Making in Psychiatric Mental Health

Instructor Name

February 12, 2026

What this page is doingThe title separates settled exclusions from open ones. A log that records every candidate as ruled out invites false confidence; one that keeps open questions visible tells the next clinician what still needs attention.

Medical Mimic Exclusion Log for Mr. K.: What Was Done, What It Returned, and Which Questions Remain Open

Purpose and Selection

This log records the non-psychiatric conditions that could produce or contribute to the presentation of Mr. K., a composite 56-year-old man with a year of apathy, fatigue, poor concentration, and low mood that did not respond to four months of sertraline. Each condition was included because something in his history, examination, or diagnostic weighting invited it, not from a general screening list. For each, the log states what was done, what it returned, and whether the question is settled or still open.

The Log

Entries are grouped by type.

Condition	Why it was considered	What was done	Result	Status
Obstructive sleep apnea	Snoring, witnessed pauses, daytime sleepiness, weight gain	STOP-Bang questionnaire; home sleep apnea test	Score 6 of 8; apnea-hypopnea index 32 events per hour	Settled: present, severe
Hypothyroidism	Fatigue, weight gain, slowed thinking	Thyroid-stimulating hormone	2.1 mIU/L, within reference range	Settled: excluded
Vitamin B12 deficiency	Cognitive complaints, alcohol use	Serum B12	410 pg/mL, within reference range	Settled: excluded
Anemia	Fatigue	Complete blood count	Hemoglobin 14.2 g/dL; mean cell volume 99 fL, mildly high	Anemia excluded; large red cells noted, consistent with alcohol
Hyponatremia	Sertraline in a man over 55; cognitive slowing	Sodium	139 mmol/L	Settled: excluded
Diabetes	Weight gain, fatigue	Glycated hemoglobin	6.1%, prediabetes range	Not explanatory; referred to primary care
Liver injury	Alcohol use	Liver panel	AST 48, ALT 39 U/L, GGT 88 U/L; mildly elevated	Open: consistent with alcohol; recheck in 3 months
Hazardous alcohol use	About 16 drinks a week	AUDIT questionnaire	Score 11	Settled: present, hazardous; contributor
Low testosterone	Fatigue, low libido, sleep apnea	Morning total testosterone, twice	240 and 255 ng/dL, low	Open: may be secondary to apnea and alcohol; recheck after treatment
Beta-blocker effect	Fatigue on metoprolol	Review with primary care	Taken eight years; symptoms began one year ago	Open, low likelihood; primary care to consider an alternative
Structural or vascular brain disease	Cognitive complaints, first episode at 56, family history	Neurological examination; cognitive screen	Examination normal; cognitive screen shows attention and retrieval deficits	Open, time-limited: reassess after 3 months of apnea treatment; imaging if not improved

How Each Exclusion Was Judged

An exclusion is settled only when the test used can answer the question. A normal TSH all but rules out primary hypothyroidism. A normal sodium excludes hyponatremia at present, although it will be rechecked if sertraline is continued. The home sleep apnea test, appropriate for a patient with a high pretest probability of moderate to severe apnea and no major cardiopulmonary disease (Kapur et al., 2017), gave a result that settles the question in the other direction: severe apnea is present.

Why Three Questions Stay Open

Low testosterone is confirmed on two morning measurements, but its cause is uncertain. Sleep apnea and heavy alcohol use can both lower testosterone, and guidance recommends addressing reversible causes before diagnosing hypogonadism and starting treatment (Bhasin et al., 2018). It will be rechecked after three months of apnea treatment and reduced drinking.

The liver tests and large red cells are consistent with alcohol and are likely to improve with reduced drinking. They will be rechecked in three months.

Structural or vascular brain disease has not been excluded, and imaging has not been done. The reasoning is explicit: his neurological examination is normal, his cognitive deficits are in attention and retrieval rather than storage, and two treatable causes of exactly these deficits, severe sleep apnea and hazardous drinking, have been found. Treating those first and repeating the cognitive screen in three months is a reasonable plan. If his cognition does not improve, or worsens, or if new signs appear, brain imaging and neurology referral will follow without further delay. The date for that decision is recorded, so the question cannot quietly close by default.

What this page is doingEach open question carries a reason it is open, a planned action, and a date. Recording a condition as excluded when the test could not exclude it is the most consequential error in a mimic log.

Conditions Considered and Not Tested

Syphilis and HIV infection can cause cognitive and mood changes but were not tested: he reported no risk factors and no symptoms suggesting either, and the clinic will revisit this if cognition does not improve. Hypercalcemia was covered by the metabolic panel, with a normal calcium. Testing was chosen for conditions the presentation actually suggested, and conditions not tested are listed with the reason, so that the choice is visible to the next reader.

What the Log Changes

Two medical conditions, severe obstructive sleep apnea and hazardous alcohol use, are now established contributors. Each can drain energy, blunt attention, and lower mood on its own, and each can keep depression from responding to treatment. The plan is referral for positive airway pressure therapy, a brief alcohol intervention with a goal agreed with Mr. K. (Babor et al., 2001), and reassessment of mood and cognition after three months, before any change to his antidepressant.

References

Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). World Health Organization.

Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715-1744. https://doi.org/10.1210/jc.2018-00229

Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(3), 479-504. https://doi.org/10.5664/jcsm.6506

What the NU 671 Unit 4 instructions ask for

Unit 4 asks you to document the medical conditions that could mimic or contribute to a psychiatric presentation and how each was assessed. Expect to explain how mimics were selected, list each with the test used, its result and your conclusion, distinguish settled from open questions and note conditions considered but not tested. Many versions ask you to cite clinical guidelines for each test. Check whether your section allows results from a composite chart. A test settles a question only if it can answer it, so explain why a normal result rules a condition out or does not. Conditions left untested need a reason. The log should end with what changes for diagnosis and treatment, since medical findings can redirect the whole plan.

How this NU 671 Unit 4 example is built

The log opens with purpose and selection, explaining that mimics were chosen from the differential and the history. Entries are grouped by type, such as endocrine, sleep and substance, each with test, result and conclusion. A section on judging exclusions explains the logic behind settled and unsettled results, using thyroid and testosterone as contrasting examples. The open questions section explains why three items remain unresolved and what would resolve them. The untested section gives reasons for each, such as no risk factors. The final section states what the log establishes, two medical contributors that can be treated, and how that changes the plan. Each test cites a guideline, so the reasoning rests on published standards rather than habit.

NU 671 Unit 4 rubric: what full points look like

Herzing's rubric for an exclusion log generally covers the selection of mimics, the appropriateness of tests, the interpretation of results, the handling of open questions, documentation of untested conditions and clinical implications. Test appropriateness and interpretation decide most of the grade: each test must be able to answer its question, and each conclusion must follow from the result. Selection points reward mimics drawn from the patient's history and differential. Open question criteria look for honest statements and next steps. Untested conditions should have reasons. Implications earn credit when the log changes the plan. Kapur's sleep apnea guideline and Bhasin's testosterone guideline belong in the APA 7 references.

Common NU 671 Unit 4 mistakes, and how to avoid them

A Unit 4 exclusion log often falls short by listing labs as normal without saying what condition each was meant to exclude. Another frequent problem is treating a single abnormal value as a diagnosis. Students often order a broad panel without reasons. Open questions are hidden. Conditions not tested are left out, so the grader cannot tell whether they were considered. Substance use is not treated as a medical contributor. Finally, end with what the log changes, because graders look for medical findings that redirect treatment, such as treating sleep apnea before increasing an antidepressant. Untested conditions also need a stated reason, such as no risk factors reported, or the reader cannot tell whether they were overlooked.

Get a NU 671 Unit 4 example written to your instructions

Send the Unit 4 instructions and the rubric from your NU 671 classroom, with the presentation driving the search. We write a custom example with candidates chosen from the features, grouping by system so gaps show, the exclusion step recorded ahead of each verdict, and the open items carrying what would settle them. First custom sample free, returned within 24 to 48 hours.

More NU 671 papers and PMHNP samples

NU 671 Unit 4 questions, answered

Which mimics should be included?

Those the presentation actually invites. A picture with recent cognitive change points somewhere different from one with weight change and cold intolerance, and the log should show that steering. Include the substance-related possibilities in every version, since they overlap more presentations than anything else, and note where a prescribed agent could be producing the picture.

Can the log rely on results from a composite chart?

Yes, and that is the usual construction: a composite person with results you specify, plainly built rather than drawn from anyone's record. Keep the values plausible and consistent with each other, and cite the reference ranges you are working from. Real results gathered during a placement stay with the site, and no example should ever carry them.

What if a mimic cannot be excluded?

Record it as open, name what would resolve it, and carry on. Psychiatric diagnosis proceeds under uncertainty routinely, and a log admitting an unresolved possibility is stronger than one declaring everything settled. Name whatever would send you back to it, since a condition declaring itself months later is the situation this documentation exists to survive.

Where can I find a free NU 671 Unit 4 sample paper?

The complete NU 671 Unit 4 mimic exclusion log is posted here free, every test with its result, the open questions and what changed. A log for a different presentation can be prepared on request.

What medical conditions can mimic depression?

Common mimics include hypothyroidism, obstructive sleep apnea, alcohol use, low testosterone, anemia and early neurocognitive disorder. This sample logs tests for each in a 56-year-old man and finds sleep apnea and heavy drinking as real contributors.

NU 671 Unit 4 medical mimic exclusion log example