| Course | NU676 PMHNP Diagnosis and Management Across the Lifespan Clinical II |
|---|---|
| Unit | Unit 10 |
| Paper type | Defended recommendation |
| Length | About 1,110 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU676 Unit 10
Six Weeks Is Too Long to Wait: A Defended Recommendation to Start Buprenorphine in the Psychiatric Clinic for a 31-Year-Old With Stable Bipolar II Disorder Buying Oxycodone
[Student Name]
Purdue University Global
NU676: PMHNP Diagnosis and Management Across the Lifespan Clinical II
Unit 10 Defended Recommendation
[Instructor Name]
[Date]
The patient is composite; doses, dates and details are bracketed.
The Situation
Ms. [K.] is a [31]-year-old stagehand for touring productions. She has bipolar II disorder, stable on lamotrigine [200] mg for [three] years, with monthly visits at this clinic. Eight months ago she injured her shoulder rigging a set and was prescribed oxycodone for [two] weeks. Since then she has continued to use oxycodone, now about [60] to [80] mg a day, bought from a coworker. She has tried to stop twice and developed withdrawal within a day: sweating, cramps, restlessness and anxiety. She meets criteria for opioid use disorder, moderate. She has not injected and has had no overdose. She asked for help, and she is worried that fentanyl is now appearing in pills sold at work.
The only addiction treatment program within reach has a [six]-week wait for an intake.
The Recommendation
Start buprenorphine-naloxone in this clinic, now, with the clinic's psychiatric nurse practitioner prescribing and the addiction program's intake kept as a referral for counseling and longer-term care. The special federal waiver once needed for office-based buprenorphine was removed in 2023, so the clinic's prescribers can treat her under their existing registration, which removes the most common barrier to starting it in a mental health clinic.
The Evidence Behind It
Buprenorphine maintenance is effective. A Cochrane review found that it retained people in treatment and reduced illicit opioid use better than placebo, and that it was comparable to methadone in suppressing opioid use among those retained, though methadone retained more people at flexible doses (Mattick et al., 2014). The mortality evidence is stronger still. A systematic review and meta-analysis of cohort studies found substantially lower all-cause and overdose mortality while people remained on buprenorphine or methadone , and a sharp rise in risk in the weeks after leaving treatment (Sordo et al., 2017). In a cohort of people who survived an opioid overdose, buprenorphine was associated with lower all-cause and opioid-related mortality (Larochelle et al., 2018).
Six weeks of waiting is six weeks of buying pills of unknown content; the question is not whether she should receive buprenorphine but whether the delay is safe, and it is not.
Why Not Refer and Wait
Referral alone might seem the cautious choice, since it leaves addiction care to specialists. But caution here is measured by what happens to her in the next six weeks. She is using daily, buying from a source she cannot check, and has already had withdrawal each time she tried to stop. The period before treatment starts is when the risk of overdose from an unexpected fentanyl-containing pill is highest, and nothing in a referral letter reduces that risk. Starting treatment now and keeping the referral is the combination that protects her in the meantime.
Objection 1: This Clinic Is Not an Addiction Program
True, but the psychiatric clinic already manages her bipolar disorder, knows her history and sees her monthly. Starting buprenorphine here uses an existing relationship and a clinician trained in pharmacology and risk assessment. The addiction program's counseling can be added when her intake date arrives.
Objection 2: Buprenorphine Might Destabilize Her Bipolar Disorder
There is no significant interaction between buprenorphine and lamotrigine. Her mood has been stable for three years. Opioid withdrawal, uncertain supply and the stress of illicit buying are more likely to destabilize her mood than a stable daily medication. Her mood will be monitored at each visit, as it already is.
Objection 3: The Risk of Diversion
Buprenorphine can be diverted, and the plan addresses it: weekly prescriptions for the first month, urine drug testing including fentanyl, a check of the state prescription monitoring program at each prescription, and a treatment agreement. The risk of diversion is real but smaller than the risk of leaving her to buy oxycodone that may contain fentanyl.
Objection 4: She Should Wait for Counseling First
Medication for opioid use disorder is effective without mandatory counseling, and waiting for counseling to start medication delays the part of treatment most strongly linked to survival. Counseling will be added, not required first.
The Plan
1. Education today on buprenorphine, precipitated withdrawal and naloxone; prescribe naloxone nasal spray today.
2. Home induction starting when she is in mild to moderate withdrawal, at least [12] hours after her last oxycodone, with [2 to 4] mg buprenorphine-naloxone, then titration over [two to three] days to about [16] mg daily, with a phone check on day [one] and day [two].
3. Visit in [one] week, then weekly for [four] weeks, then every [two] weeks.
4. Urine drug testing at each visit for the first month; prescription monitoring program check at each prescription.
5. Keep the addiction program intake in six weeks for counseling and peer support.
6. Continue lamotrigine unchanged; mood check at each visit.
7. Talk with her about her work: touring schedules can interrupt refills, so plan pharmacy access in advance for tours.
What She Was Told and What She Decided
The recommendation was explained to her at the same visit. Buprenorphine is a medicine that settles withdrawal and cravings and protects against overdose; it is taken once a day and can be started at home. She would need to wait until she felt moderately unwell from withdrawal before the first dose, because taking it too early can bring on sudden withdrawal. She was told that the clinic would check her urine and the state prescription database, not as a sign of distrust but as part of the standard of care, and that her bipolar treatment would continue unchanged. She asked whether her employer would find out; she was told that her treatment is confidential and that federal rules protect substance use treatment records. She asked whether she would be on it forever; she was told that many people stay on it for a long time because stopping raises the risk of relapse and overdose, and that the decision would be hers, revisited over time. She chose to start that weekend, when she had no show, and her partner agreed to be with her on the first day.
Conclusion
Starting buprenorphine now is safe, effective and within the scope of a psychiatric clinic, and the objections to it can each be met with a specific safeguard. The alternative, waiting six weeks, carries a risk that none of the objections outweighs.
References
Larochelle, M. R., Bernson, D., Land, T., Stopka, T. J., Wang, N., Xuan, Z., Bagley, S. M., Liebschutz, J. M., & Walley, A. Y. (2018). Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study. Annals of Internal Medicine, 169(3), 137-145. https://doi.org/10.7326/M17-3107
Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2014(2), Article CD002207. https://doi.org/10.1002/14651858.CD002207.pub4
Sordo, L., Barrio, G., Bravo, M. J., Indave, B. I., Degenhardt, L., Wiessing, L., Ferri, M., & Pastor-Barriuso, R. (2017). Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies. BMJ, 357, Article j1550. https://doi.org/10.1136/bmj.j1550
Reading the NU 676 Unit 10 instructions
The final NU676 assignment asks you to make and defend a treatment recommendation for a complex patient. Prompts usually want the situation, a clear recommendation, the evidence behind it, the strongest objections a colleague or supervisor might raise with a response to each, and a detailed plan. Five to six pages is common. Faculty reward recommendations that face their objections directly and answer each one with evidence or a safeguard, rather than ignoring them. Showing that you considered the alternative, here waiting for a specialty program, and why it was worse, strengthens the defense. Recording the patient's questions and decision shows that the recommendation was offered to her rather than imposed.
How the NU 676 Unit 10 example is put together
The situation section describes her injury, her daily oxycodone use, two failed attempts to stop and her fear of fentanyl, and the six-week wait. The recommendation follows, including the 2023 removal of the special waiver. The evidence section covers the Cochrane review, the Sordo mortality meta-analysis and the Larochelle overdose cohort, with a highlighted sentence on the danger of waiting. A section explains why referral alone is not the cautious choice. Four objections, scope, bipolar stability, diversion and counseling, are each answered. A seven-step plan covers naloxone, home induction and her touring schedule, and a section records her questions and decision before the conclusion.
Reading the NU676 Unit 10 grading rubric
Defended recommendations are usually graded on the clarity of the recommendation, strength of the evidence, handling of objections, the plan and the patient's involvement. Clarity earns full marks when the recommendation is stated early and specifically. Evidence credit goes to sources that address the outcome that matters most, here mortality. Handling of objections is judged on whether each is stated fairly and answered with a concrete safeguard. The plan row rewards steps a covering clinician could follow, including induction timing and monitoring. The last row asks whether her own questions, fears and choices are visible in the paper and helped set the timing of the start. APA accuracy completes the marks.
NU676 Unit 10 help: mistakes that cost points
A common weakness is a recommendation that avoids the obvious objections, which a reviewer will raise anyway. Another is citing retention and drug-use outcomes while leaving out mortality, the strongest argument. Students often forget naloxone, which should be prescribed the same day. Some plans start buprenorphine too soon after the last opioid, risking precipitated withdrawal. Others treat bipolar disorder as a reason to delay rather than a condition to monitor. And ignoring the patient's work schedule, especially touring or shift work, can leave her without refills at the moment she most needs them, undoing a good start. Put naloxone in the first line of the plan, not the last, so it is never forgotten when the prescription is written.
Get an NU676 Unit 10 example written to your instructions
Outline the recommendation your NU676 Unit 10 case calls for, the time limit, the rubric and the objections your preceptor or seminar is likely to raise, with the case de-identified. A free first presentation returns in 24-48h: recommendation first, a composite case trimmed to what the decision needs, and an objections table with a source behind every answer. 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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NU676 Unit 10 questions, answered
Can a psychiatric nurse practitioner prescribe buprenorphine for opioid use disorder?
Since the Consolidated Appropriations Act of 2023, federal law no longer requires the separate DATA waiver; a prescriber with a current DEA registration covering Schedule III medications may prescribe it, subject to state law. Nurse practitioner scope varies by state, and some sites add their own requirements, so a presentation should cite the rules that apply where the patient is treated.
Does the sample give treatment advice for a real patient?
No. It is a composite case written to show how a recommendation is structured and defended, with every drug and dose bracketed. Decisions about a real patient belong to the treating clinician, the site's protocols and the preceptor supervising you. The sample's value is in its reasoning and sourcing, which you would rebuild around your own case.
Where can I find a free NU676 Unit 10 sample paper?
This page gives the full NU676 Unit 10 defended recommendation, with the evidence, four objections and answers, a seven-step plan and her questions and decision, plus three references. A defended recommendation for your own patient can be requested.
Why start buprenorphine instead of waiting in NU676 Unit 10?
Treatment with buprenorphine is associated with much lower overdose and all-cause mortality, and the weeks before treatment starts carry high risk for someone buying pills that may contain fentanyl. Starting now and keeping the referral protects her in the meantime.
How is buprenorphine started at home in NU676 Unit 10?
She waits until she is in mild to moderate withdrawal, at least 12 hours after her last oxycodone, then takes 2 to 4 mg and titrates over two to three days toward about 16 mg daily, with phone checks on the first two days and naloxone at home.