| Course | NU 671 Clinical Decision-Making in Psychiatric Mental Health |
|---|---|
| Unit | Unit 6 |
| Paper type | Rating instrument administration note |
| Length | About 720 words, 5 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 6
Rating Instrument Note: Montreal Cognitive Assessment for Mr. K., Why It Was Chosen, What It Returned, and What It Changed
Student Name
Department of Nursing, Herzing University
NU 671: Clinical Decision-Making in Psychiatric Mental Health
Instructor Name
February 26, 2026
Rating Instrument Note: Montreal Cognitive Assessment for Mr. K., Why It Was Chosen, What It Returned, and What It Changed
Instrument and Conditions
Instrument: Montreal Cognitive Assessment, English version 8.1, the full paper form. Administered by: the treating psychiatric nurse practitioner, trained and certified in its administration. Conditions: clinic office, door closed, 11 a.m., at the second visit, on February 24. Mr. K. reported sleeping about five hours the night before with frequent waking; he had not yet started positive airway pressure therapy for the severe obstructive sleep apnea found on his home sleep test. He wore his reading glasses and reported no hearing difficulty. He had consumed his usual two beers the evening before. These conditions are recorded because they bear directly on the score.
Why This Instrument
The clinical question was whether Mr. K. has a cognitive impairment beyond what depression and sleep deprivation would explain, given his cognitive complaints, his mother's dementia, and bedside findings of reduced attention and delayed recall that improved with cues. The Mini-Mental State Examination was considered and rejected: it is relatively insensitive to mild impairment, especially in executive function. The Montreal Cognitive Assessment was designed to detect mild cognitive impairment and, in its validation study, detected it far more often than the Mini-Mental State Examination (Nasreddine et al., 2005). It also tests executive function, attention, and delayed recall with cued and multiple-choice recognition, allowing retrieval problems to be distinguished from storage problems, which was the key question from the bedside examination.
What It Returned
Total score 22 of 30, including the standard 1-point adjustment for 12 or fewer years of formal education; the raw score was 21. The published cutoff for normal is 26 or higher.
| Domain | Score | Detail |
|---|---|---|
| Visuospatial and executive | 4 of 5 | Trail-making and cube correct; clock contour and numbers correct, hands misplaced |
| Naming | 3 of 3 | All animals named |
| Attention | 4 of 6 | Digits forward correct, backward failed; letter tapping correct; serial sevens 3 of 5 correct |
| Language | 1 of 3 | One sentence repeated correctly of two; produced 8 F-words in a minute, short of the 11 that earn the point |
| Abstraction | 2 of 2 | Both similarities correct |
| Delayed recall | 2 of 5 | Two words recalled freely; two more with category cues; the last with multiple choice, so all five were recognized |
| Orientation | 5 of 6 | Date given as the 23rd instead of the 24th |
Interpreting the Score Under These Conditions
A score of 22 is below the published cutoff. Two considerations limit what it can mean. First, the cutoff of 26 produces many false positives in some populations, and later work has suggested a lower cutoff to reduce misclassification (Carson et al., 2018); a score of 22 remains low under either cutoff, but the point illustrates that the number is not a diagnosis. Second, and more important here, the test was taken by a man with untreated severe sleep apnea after a poor night, who meets criteria for a depressive episode. Both conditions reduce attention, working memory, verbal fluency, and free recall, which are exactly the domains where he lost points.
The pattern within the score matters more than the total. He lost points in attention, fluency, and free recall, while naming, abstraction, and orientation apart from the date were intact, and every word he could not recall freely he recognized with cues or choices. That pattern suggests impaired retrieval and attention rather than a failure to store new information.
What the Result Changed
Before the test, the diagnostic weighting placed early neurocognitive disorder as a possible explanation, with the bedside cued-recall finding weighing against Alzheimer disease. The test confirmed that the cognitive deficits are real and measurable, not only reported, and it confirmed the retrieval pattern with a structured measure. It did not settle whether the deficits will resolve. The result therefore changed the plan in two ways: it made the three-month reassessment after sleep apnea treatment and reduced drinking more important, and it set a clear threshold for escalation. If the repeat score, using an alternate version to limit practice effects, has not improved, or if the pattern shifts toward failed recognition, he will be referred for neuropsychological testing and brain imaging.
Companion Measure
At the same visit, Mr. K. completed the Patient Health Questionnaire-9, a nine-item self-report depression measure (Kroenke et al., 2001). He scored 16, in the moderately severe range, with the highest item scores on loss of interest, sleep, and fatigue, two of which overlap with apnea symptoms. It will be repeated at each visit to track depressive symptoms alongside cognition.
What Mr. K. Was Told
He was told that the test showed real difficulties with attention and recall, that the pattern is the kind often seen with poor sleep and depression, that it is not the pattern typical of Alzheimer disease, and that the test will be repeated after his sleep is treated. He said it was the first time in months he felt someone had taken his memory worries seriously without confirming his worst fear.
References
Carson, N., Leach, L., & Murphy, K. J. (2018). A re-examination of Montreal Cognitive Assessment (MoCA) cutoff scores. International Journal of Geriatric Psychiatry, 33(2), 379-388. https://doi.org/10.1002/gps.4756
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
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
Reading the NU 671 Unit 6 instructions
Unit 6 asks you to select, administer and interpret a standardized rating instrument and document the process. Expect to state the instrument, version and conditions, explain why it was chosen, report the score, interpret it with attention to conditions that affect validity, explain what the result changed and describe what the patient was told. Many versions ask about copyright and training requirements, which apply to some instruments such as the MoCA. Check which instruments your section allows. Interpretation should consider cutoffs and the patient's circumstances, such as education, sleep or mood. A result can contradict the clinical picture, so say how you weighed it. The note should show the instrument informed a decision rather than ending as a number in the chart.
How the NU 671 Unit 6 example is put together
The note opens with the instrument, version, form, administrator and setting, which lets a reader judge the conditions. The selection section ties the choice to a specific clinical question. The results section gives the total and subscores with the education adjustment. The interpretation section is the core, setting the score against the published cutoff and a later study suggesting a different one, then listing conditions that could lower it. The change section explains how the score moved the differential without settling it. The companion measure section reports a depression score, which helps separate mood from cognition. The final section records how the result was explained to Mr. K. in plain terms, including the plan to retest after sleep apnea treatment.
Reading the NU 671 Unit 6 rubric
Herzing's rubric for an instrument note generally covers the selection rationale, the administration details, accurate scoring, interpretation, clinical impact and communication with the patient. Interpretation is what graders weigh most, because a score means little without attention to cutoffs and conditions that affect validity. Selection points reward a clear clinical question. Administration criteria look for version, form and conditions. Scoring accuracy includes correct adjustments. Clinical impact earns credit when the result changes the differential or plan. Communication points go to a plain explanation for the patient. Nasreddine's validation study and Carson's cutoff reexamination belong in the APA 7 references. Copyright and training requirements for instruments such as the MoCA may be scored under administration.
NU 671 Unit 6 help before you submit
Instrument notes in Unit 6 usually lose points by reporting a score and a cutoff without considering conditions that affect it. Another frequent problem is no clear reason for choosing the instrument. Students often forget the education adjustment or report the wrong version. The result is treated as a diagnosis. What changed is not stated. The patient explanation is missing or uses jargon. Copyright and training requirements are ignored. Finally, plan a retest when conditions change, because graders look for awareness that a score taken during untreated sleep apnea and depression may not reflect baseline cognition. Subscores are often left out, though the pattern across attention, recall and executive items helps separate mood effects from neurodegeneration.
Get a NU 671 Unit 6 example written to your instructions
Send the Unit 6 instructions and the rubric from your NU 671 classroom, naming the instrument if your course specifies one. We write a custom example opening on the question that prompted administration, stating the validation population, recording the conditions, reporting items before totals, and closing on what the result changed. First custom sample free, returned in 24 to 48 hours.
More NU 671 papers and PMHNP samples
- NU 671 Unit 1: Annotated intake interview
- NU 671 Unit 2: Mental status examination record
- NU 671 Unit 3: Diagnostic weighting table
- NU 671 Unit 4: Medical mimic exclusion log
- NU 671 Unit 5: Diagnostic criteria mapping
- NU 671 Unit 7: Collateral information summary
- NU 671 Unit 8: Biopsychosocial formulation
- NU 674 Unit 6: Shared decision making record
- NU 670 Unit 6: Special population handling brief
- NU 672 Unit 6: In-session ethical decision record
- NU 673 Unit 6: Follow-up interval rationale
NU 671 Unit 6 questions, answered
Which instrument should the note use?
One matching the question and the population, named in your instructions where they specify it. Screening instruments, severity measures and structured diagnostic interviews do different jobs, and choosing carelessly across those categories is more visible than picking the wrong scale within one. Say why the alternatives were rejected, because that comparison is often where the reasoning shows.
Do copyright restrictions affect the assignment?
They can. Several widely used instruments are licensed, and reproducing a full scale inside a submitted file is not always permitted. Describe the instrument, cite it, report the items your reasoning turns on, and check the publisher's terms before including the whole text. Where a freely available alternative answers the same question, explaining that choice is perfectly defensible.
Can a result contradict the clinical picture?
It can, and those notes are usually the strongest ones. A total disagreeing with the interview raises questions about the setting, the reporter, the period the instrument covers or the picture itself, and working through that disagreement demonstrates more than a result simply confirming what was expected. Record what you concluded and what stayed unresolved rather than picking a winner.
Where can I find a free NU 671 Unit 6 sample paper?
This page carries the complete NU 671 Unit 6 MoCA note at no cost, from the clinical question and score to interpretation and what Mr. K. was told. A note for a different instrument, such as the PHQ-9 or GAD-7, can be prepared on request.
Can depression lower a MoCA score?
Yes. Depression and sleep deprivation both affect attention and recall, which can lower Montreal Cognitive Assessment scores. This sample interprets a score of 22 with that in mind and plans to retest after sleep apnea treatment.