NRNP-6645C-101 Week 11 Final Exam
Walden PMHNP exam case file
WALDEN UNIVERSITY
PMHNP CASE EXAM SUBMISSION FILE (FORMAL
FORMAT)
Student Name: ___________________________
Walden ID: ______________________________
Course: NRNP-6645C-101
Assignment: Week 11 Final Exam – Comprehensive Case-Based Practice Exam
Instructor: ______________________________
Date Submitted: __________________________
CASE PRESENTATION
Patient Identifying Data
Initials: M.J.
Age: 29 years
Gender: Male
Race/Ethnicity: African American
Marital Status: Single
Employment: Warehouse supervisor
Insurance: Medicaid
Living Situation: Lives alone in an apartment
Source of Information: Patient self-report
Reliability: Fair (limited insight, mild paranoia present)
CHIEF COMPLAINT (CC)
“I can’t sleep, I’m always on edge, and sometimes I feel like people are watching me.”
, HISTORY OF PRESENT ILLNESS (HPI)
M.J. is a 29-year-old African American male presenting for psychiatric evaluation due to
worsening mood instability, anxiety, and suspiciousness for approximately six months, with
significant worsening over the past three weeks. The patient reports persistent insomnia with
sleep limited to 2–3 hours per night, racing thoughts, irritability, and increased energy. He
reports episodes of elevated mood characterized by increased talkativeness, impulsive spending,
and increased socialization lasting 4–6 days and occurring every few months. He also reports
periods of depressed mood lasting 1–2 weeks.
Additionally, the patient endorses panic-like symptoms including palpitations, sweating, chest
tightness, and a sense of impending doom occurring 2–3 times per week. He reports trauma-
related nightmares and hypervigilance following an armed robbery two years ago. He also
reports intermittent auditory perceptual disturbances described as hearing his name whispered.
The patient reports that he was previously prescribed sertraline 50 mg daily by his primary care
provider four months ago, but discontinued after three weeks due to feeling “wired,” restless, and
unable to stop talking, raising concern for antidepressant-induced mood switching.
PAST PSYCHIATRIC HISTORY
Previous diagnoses: None formally diagnosed
Previous therapy: None consistent
Previous psychiatric medications: Sertraline 50 mg (stopped after 3 weeks due to
activation)
Psychiatric hospitalizations: Denies
Suicide attempts: Denies
Self-harm history: Denies
History of violence: Denies
SUBSTANCE USE HISTORY
Alcohol: 2–4 beers on weekends
Cannabis: Daily use (vape pen), states it helps him “calm down”
Cocaine: Used a few times within the past year
Tobacco: ½ pack/day
Caffeine: Moderate intake daily
Withdrawal symptoms: Denies
Walden PMHNP exam case file
WALDEN UNIVERSITY
PMHNP CASE EXAM SUBMISSION FILE (FORMAL
FORMAT)
Student Name: ___________________________
Walden ID: ______________________________
Course: NRNP-6645C-101
Assignment: Week 11 Final Exam – Comprehensive Case-Based Practice Exam
Instructor: ______________________________
Date Submitted: __________________________
CASE PRESENTATION
Patient Identifying Data
Initials: M.J.
Age: 29 years
Gender: Male
Race/Ethnicity: African American
Marital Status: Single
Employment: Warehouse supervisor
Insurance: Medicaid
Living Situation: Lives alone in an apartment
Source of Information: Patient self-report
Reliability: Fair (limited insight, mild paranoia present)
CHIEF COMPLAINT (CC)
“I can’t sleep, I’m always on edge, and sometimes I feel like people are watching me.”
, HISTORY OF PRESENT ILLNESS (HPI)
M.J. is a 29-year-old African American male presenting for psychiatric evaluation due to
worsening mood instability, anxiety, and suspiciousness for approximately six months, with
significant worsening over the past three weeks. The patient reports persistent insomnia with
sleep limited to 2–3 hours per night, racing thoughts, irritability, and increased energy. He
reports episodes of elevated mood characterized by increased talkativeness, impulsive spending,
and increased socialization lasting 4–6 days and occurring every few months. He also reports
periods of depressed mood lasting 1–2 weeks.
Additionally, the patient endorses panic-like symptoms including palpitations, sweating, chest
tightness, and a sense of impending doom occurring 2–3 times per week. He reports trauma-
related nightmares and hypervigilance following an armed robbery two years ago. He also
reports intermittent auditory perceptual disturbances described as hearing his name whispered.
The patient reports that he was previously prescribed sertraline 50 mg daily by his primary care
provider four months ago, but discontinued after three weeks due to feeling “wired,” restless, and
unable to stop talking, raising concern for antidepressant-induced mood switching.
PAST PSYCHIATRIC HISTORY
Previous diagnoses: None formally diagnosed
Previous therapy: None consistent
Previous psychiatric medications: Sertraline 50 mg (stopped after 3 weeks due to
activation)
Psychiatric hospitalizations: Denies
Suicide attempts: Denies
Self-harm history: Denies
History of violence: Denies
SUBSTANCE USE HISTORY
Alcohol: 2–4 beers on weekends
Cannabis: Daily use (vape pen), states it helps him “calm down”
Cocaine: Used a few times within the past year
Tobacco: ½ pack/day
Caffeine: Moderate intake daily
Withdrawal symptoms: Denies
