| Course | NU675 PMHNP Diagnosis and Management Across the Lifespan II |
|---|---|
| Unit | Unit 5 |
| Paper type | Seminar reflection |
| Length | About 790 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU675 Unit 5
Four Equal Cuts in Four Weeks: A Seminar Reflection on Deprescribing Bedtime Quetiapine for a 71-Year-Old Retired Church Organist
[Student Name]
Purdue University Global
NU675: PMHNP Diagnosis and Management Across the Lifespan II
Unit 5 Seminar Reflection
[Instructor Name]
[Date]
The patient and seminar group are composite; doses and timelines are bracketed.
The Case and My Plan
Our fifth seminar case was Mrs. [P.], a [71]-year-old retired church organist who has taken quetiapine [100] mg at bedtime for [six] years. It was started by a hospital team after a hip operation, when she was sleeping poorly and briefly confused, and never stopped. She has no psychotic or bipolar illness. She has gained [8] kg, her fasting glucose is now [118] mg/dL, and she is unsteady when she gets up at night. She wants to stop because "I don't want to be on an antipsychotic for sleep."
I came to the seminar with a plan I thought was simple and safe: reduce by [25] mg each week, finishing in four weeks. Low-dose quetiapine for insomnia is not recommended; a review of the evidence found limited benefit and safety concerns including weight gain, metabolic changes, akathisia and restless legs (Coe & Hong, 2012). A broader review of off-label atypical antipsychotic use similarly found little evidence for insomnia (Maher et al., 2011). I thought the only question was how fast.
What the Group Asked
The facilitator asked me to describe what Mrs. [P.] would experience in the first week after each cut. I said she might sleep worse. A classmate, Grace, pointed out that after six years of nightly use, the first cut, from [100] to [75] mg, would be the gentlest, and the last, from [25] mg to nothing, would remove all of the drug's effect at once. She asked why the steps were equal when the effect of each step was not.
The facilitator then brought in the argument from the antidepressant literature that tapering should be proportional rather than linear, with smaller absolute reductions at lower doses, because the relationship between dose and receptor effect is not a straight line (Horowitz & Taylor, 2019). That paper concerned serotonin reuptake inhibitors, and the group agreed that it should be applied to quetiapine with caution. But the principle, that the last milligrams matter more than the first, made immediate sense of Grace's question.
I had planned the taper in milligrams, which are easy to count, rather than in what she would feel, which is what decides whether a taper succeeds.
What the Group Also Asked
Another classmate asked what would replace quetiapine for her sleep. I had no plan. The group suggested that cognitive behavioral therapy for insomnia start before the first reduction, since it has strong evidence for chronic insomnia and would give her tools for the nights when sleep worsened (Trauer et al., 2015). A third question was who decides the pace. The facilitator suggested that Mrs. [P.] should, within limits, holding each step until her sleep settled.
How My Plan Changed
The revised plan, drawn up by the group:
1. Begin cognitive behavioral therapy for insomnia [two] weeks before the first reduction.
2. Reduce from [100] to [75] mg, then [50], then [37.5], then [25], then [12.5], then stop, with each step lasting at least [two] weeks and longer if she chooses.
3. Hold any step until her sleep diary has been stable for a week.
4. Tell her plainly that a few poor nights should be expected after each step and is expected, not a sign of failure.
5. Recheck weight and glucose at [three] and [six] months.
6. Address her night-time unsteadiness at once, with a night light and a bedside commode, since the taper will take months.
The revised taper will take about [four] months rather than four weeks.
What I Learned About My Own Thinking
I noticed that my confidence came from being right about the main question, that she should stop, and that this made me careless about the second question, how. I had also treated the patient as the recipient of a schedule rather than its co-author. The group's plan is slower, but it is more likely to finish.
What I Will Do Differently
1. When planning any taper of a long-term medication, I will ask what the patient will feel at each step, not only what the dose will be.
2. I will make the steps smaller as the dose gets lower, and I will state clearly that this principle comes mainly from antidepressant evidence when I apply it to other drugs.
3. I will plan what replaces the drug's benefit before removing it.
4. I will let the patient set the pace within agreed limits and write that into the plan.
References
Coe, H. V., & Hong, I. S. (2012). Safety of low doses of quetiapine when used for insomnia. Annals of Pharmacotherapy, 46(5), 718-722. https://doi.org/10.1345/aph.1Q697
Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538-546. https://doi.org/10.1016/S2215-0366(19)30032-X
Maher, A. R., Maglione, M., Bagley, S., Suttorp, M., Hu, J.-H., Ewing, B., Wang, Z., Timmer, M., Sultzer, D., & Shekelle, P. G. (2011). Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: A systematic review and meta-analysis. JAMA, 306(12), 1359-1369. https://doi.org/10.1001/jama.2011.1360
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191-204. https://doi.org/10.7326/M14-2841
Reading the NU 675 Unit 5 instructions
The Unit 5 reflection asks you to describe how a seminar discussion changed your approach to a medication decision. Prompts usually want your original plan and the reasoning behind it, the questions or evidence raised, the specific point at which your plan changed, what the revised plan looks like, and the changes you will make. Expect to write about 900 words in the first person, with citations for the evidence discussed. Faculty value honesty about what made your first plan attractive and precision about the turning point. When evidence from one drug class is applied to another, say so and note the limits, which shows careful reasoning rather than borrowed certainty.
How this NU675 Unit 5 example is built
The reflection sets out Mrs. P., her six years on quetiapine, her weight gain, glucose and night-time unsteadiness, and the author's four-week plan, with the Coe and Maher reviews on why low-dose quetiapine for sleep should stop. The seminar section records the facilitator's question, a classmate's point about the last step, and the proportional tapering argument, with the caution that it came from antidepressant research. A highlighted sentence names the author's error. Further questions bring in CBT for insomnia and patient-set pacing. The revised six-step plan follows, then a paragraph on the author's own thinking and four commitments a preceptor could see in the next taper.
NU675 Unit 5 rubric: what earns full points
Instructors mark these reflections on five things: honest self-examination, a clear turning point, careful use of evidence, a sound revised plan and learning that carries forward. The first of these is met when the author says why the original plan felt right at the time. The turning point should be tied to a particular question and the person who asked it. Evidence points reward accurate use of sources, including the caution that tapering evidence comes from a different drug class. The revised plan is judged on whether it addresses the problems the discussion raised. Specific learning credit goes to commitments that apply to future tapers generally, not only to quetiapine, and that could be checked in practice.
NU675 Unit 5 help from the desk
A reflection that retells the seminar instead of tracing how your own reasoning moved will lose most of its marks. Another common weakness is presenting the revised plan without explaining which question produced each change. Some reflections apply antidepressant tapering evidence to other drugs without noting the difference. Others stop the medicine without planning what will replace its benefit, here help with sleep. Many forget to address the safety issue already present, such as night-time falls. And commitments like "be more careful with tapers" cannot be checked; write the specific habit you will use next time and when you will use it. Keep the patient's pace at the center.
Get an NU675 Unit 5 example written to your instructions
Seminar sessions in NU675 Unit 5 often end with a draft schedule on screen; send that, or, if you skipped the live hour, the alternative assignment's prompt, along with your own starting view and the rubric. Your first custom reflection is free within 24-48h and follows the schedule step by step. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU675 Unit 5 questions, answered
Can a seminar reflection include a full taper schedule?
It can show the schedule's shape, with every figure bracketed as composite, since the reasoning behind the steps is the subject. Say why each step is sized as it is and what would pause it. Spend most of the page on how your view moved; graders read a long dosing table as a lapse from reflection, and nothing in it should read as instructions for a real patient.
What if I attended the seminar but said little?
The reflection can still be strong. What matters is the change in your own reasoning, not how much you spoke. Describe the view you held, the contribution or reading that challenged it and what you now think. Where a classmate made the decisive point, credit the idea without naming the person, and show what you did with it afterward.
How should the reflection handle a question the group never settled?
Leave it open and say why. Set out each position with its strongest evidence, then state which way you lean and what would move you. Graders tend to value an honest account of disagreement over a tidy ending, especially on questions like drug switching during a taper, where the evidence itself is mixed.
Where can I find a free NU675 Unit 5 sample paper?
The full NU675 Unit 5 seminar reflection is available on this page, with the original plan, the group's questions, the revised taper, the author's reflection on their own thinking and four commitments, plus four references. Share the notes from your own seminar and a reflection can be shaped around them.
Why do the taper steps get smaller in NU675 Unit 5?
Because the effect of each milligram is not constant; the last steps remove proportionally more of the drug's effect than the first. The argument comes mainly from antidepressant research, so the reflection applies it to quetiapine with caution and lets the patient hold any step.