| Course | NU676 PMHNP Diagnosis and Management Across the Lifespan Clinical II |
|---|---|
| Unit | Unit 4 |
| Paper type | Side effect review |
| Length | About 610 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU676 Unit 4
He Calls It Nerves: A Side Effect Review That Finds Akathisia in a 26-Year-Old Projectionist Taking Aripiprazole
[Student Name]
Purdue University Global
NU676: PMHNP Diagnosis and Management Across the Lifespan Clinical II
Unit 4 Side Effect Review
[Instructor Name]
[Date]
The patient is composite; doses, scores and dates are bracketed.
Context
Mr. [M.], [26], schizophrenia, stable for [two] years. Aripiprazole was increased from [10] to [20] mg [five] weeks ago after a brief return of suspiciousness at work. He came today asking for "something for my nerves."
Adverse Effects Asked About by Name
Rather than asking whether he has any side effects, each likely effect of his medication was named and asked about in turn.
1. Restlessness, an inner urge to move, trouble sitting still: yes, since about [four] weeks ago. "I can't sit through a film anymore. My legs won't let me." He paces the projection booth between reels.
2. Stiffness or slowness: no.
3. Tremor: no.
4. Abnormal movements of the mouth, tongue or face: no, and his mother, who came with him, has not noticed any.
5. Sleep: falls asleep late because he "can't lie still."
6. Weight and appetite: no change; weight [78] kg.
7. Sexual side effects: none.
8. Nausea or headache: mild headache in the first week after the increase, resolved.
9. Anxiety or worry: he says he is not worried about anything specific; the feeling is "in my body, not my head."
The distinction he drew in the last answer is the key clinical finding. Akathisia is characterized by a subjective sense of restlessness, often felt in the legs, together with observable restless movements, and it can be mistaken for anxiety or agitation (Poyurovsky, 2010).
Movement Scores
1. Barnes Akathisia Rating Scale. Objective: [2], shifts position and rocks from foot to foot while standing. Subjective awareness: [2]. Subjective distress: [2]. Global clinical assessment: [3], moderate akathisia. The scale was designed to rate drug-induced akathisia with separate objective, subjective and global items (Barnes, 1989).
2. Abnormal Involuntary Movement Scale: total [0]; no signs of tardive dyskinesia (Guy, 1976).
He named the feeling correctly as a physical restlessness, and the scale confirmed what his words already said: this is akathisia, not anxiety.
Assessment
Moderate akathisia, onset about a week after the aripiprazole increase to [20] mg. No parkinsonism or tardive dyskinesia. His psychosis remains in remission since the increase; the suspiciousness has not returned.
The main risks of missing this diagnosis are real. Akathisia is distressing, is associated with poor adherence, and in some patients with worsening agitation; adding a benzodiazepine or another medicine for "nerves" would treat the wrong problem.
Plan
1. Reduce aripiprazole to [15] mg daily. Rationale: onset followed the dose increase, and his psychosis was stable at lower doses before the recent episode.
2. If akathisia persists after [two] weeks, start propranolol [10] mg twice daily, checking pulse and blood pressure first. Reviews of acute antipsychotic-induced akathisia describe dose reduction and propranolol among the main management options, with low-dose mirtazapine as another (Poyurovsky, 2010).
3. Repeat the Barnes scale at the next visit and at each dose change.
4. Ask him and his mother to watch for any return of suspiciousness during the dose reduction, and to call if it appears.
5. Follow-up in [two] weeks.
What the Patient Was Told
The restlessness is a known side effect of his medicine at the higher dose, not a sign that he is becoming anxious or unwell. It is expected to improve with a lower dose, and there is a second option if it does not. He was relieved: "So I'm not losing it."
References
Barnes, T. R. E. (1989). A rating scale for drug-induced akathisia. British Journal of Psychiatry, 154(5), 672-676. https://doi.org/10.1192/bjp.154.5.672
Guy, W. (1976). ECDEU assessment manual for psychopharmacology (DHEW Publication No. ADM 76-338). U.S. Department of Health, Education, and Welfare.
Poyurovsky, M. (2010). Acute antipsychotic-induced akathisia revisited. British Journal of Psychiatry, 196(2), 89-91. https://doi.org/10.1192/bjp.bp.109.070540
What the NU676 Unit 4 assignment asks for
For Unit 4 you review a patient's possible medication side effects systematically. The assignment usually asks you to list the likely adverse effects of the specific drug, ask about each by name, use standardized rating scales where they exist, interpret the findings against the timing of dose changes, and state what the findings mean for treatment. The review is normally written as a note of two or three pages. The central skill is avoiding a quick label: a complaint such as nerves or tiredness can be a side effect, the illness or something unrelated, and the review should show how you decided. Using two instruments for two different questions, such as akathisia and tardive dyskinesia, demonstrates precise assessment.
Inside the NU676 Unit 4 example
A context line gives the diagnosis, the recent dose increase and his request. Nine adverse effects are then listed with his answer to each, including his distinction between body and head. The Poyurovsky review supports that distinction. The Barnes Akathisia Rating Scale is reported item by item with a global score of 3, and the AIMS total of 0 is cited to the ECDEU manual. A highlighted sentence explains how his words and the scale agreed. The assessment ties onset to the dose increase and names the harm of treating akathisia as anxiety. Five plan items follow, then a short account of what he was told and his relieved response.
Reading the NU676 Unit 4 grading rubric
Side effect reviews are usually graded on systematic coverage, use of validated scales, interpretation against timing, clinical reasoning and communication with the patient. Coverage rewards naming each likely effect of the specific drug rather than a general question about side effects. Scales earn full credit when the right instrument is chosen for each question and its scoring is reported. Interpretation is judged on whether onset is linked to a dose change or new drug. Reasoning points go to naming what else the complaint could be and why it was ruled out. Communication credit depends on a plain explanation the patient can understand and repeat to his family.
NU676 Unit 4 help from the desk
The most frequent mistake is accepting the patient's own label, such as nerves, and treating anxiety. Another is asking only whether there are any side effects, which misses effects patients do not connect to the drug. Students often score tardive dyskinesia but forget akathisia, or the reverse. Some reviews report a scale total without the item scores that explain it. Others recommend adding a benzodiazepine, which treats the distress but not the cause and adds its own risks. And a review that never tells the patient what is happening leaves him believing he is getting worse, which can end his willingness to keep taking the medicine at all. Ask his family what they have noticed as well.
Get an NU676 Unit 4 example written to your instructions
Movement and metabolic monitoring differ by site, so send the drug, the care setting and the rating instruments your NU676 placement uses, along with the Unit 4 prompt and the rubric. A first review is free and back in 24-48h: a composite patient questioned effect by effect, movement scales scored as published, and a summary that reports findings for the prescriber. 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 4 questions, answered
What does the AIMS measure, and how is it scored?
The Abnormal Involuntary Movement Scale, developed at the National Institute of Mental Health, rates dyskinetic movements in facial and oral areas, extremities and trunk from none to severe, adds global judgments of severity, incapacitation and awareness, and records dental status. It is not a measure of akathisia or parkinsonism. Repeating it on a schedule is what makes change visible.
How is akathisia different from anxiety?
Both can feel like inner tension, but akathisia usually brings an urge to move, often felt in the legs, and observable restlessness such as rocking, shifting weight or pacing, and it tends to follow starting or raising certain medications. Anxiety centers on worry. The Barnes scale separates what is seen from what is felt, which helps a review tell the two apart.
Where can I find a free NU676 Unit 4 sample paper?
The complete NU676 Unit 4 side effect review is on this page, with nine effects asked about by name, Barnes and AIMS scores, the assessment, a five-step plan and what he was told, plus three references. A review for your own patient's medication can be requested.
What treats akathisia in NU676 Unit 4?
The plan first lowers aripiprazole from 20 to 15 mg, since onset followed the increase. If restlessness persists after two weeks, propranolol is added after checking pulse and blood pressure; low-dose mirtazapine is another option described in reviews.
How is akathisia scored in NU676 Unit 4?
With the Barnes Akathisia Rating Scale, which rates objective restlessness, subjective awareness and distress, and gives a global score. He scored 2 on each of the first three and 3 on the global item, moderate akathisia.