assessment 3 concept map

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Patient Overview

Knowledge Check Type Score

Vitals/Health History Multiple Choice 4/4 (100%)

Inquiry Multiple Choice 4/4 (100%)

ROS Multiple Choice 4/4 (100%)

Assessment Multiple Choice 0/4 (0%)

Assessment Open Response 4/5 (80%)

Diagnostics Open Response 4/5 (80%)

Final Diagnosis Open Response 3/5 (60%)

Medication Open Response 5/5 (100%)

Education Open Response 4/5 (80%)

Plan of Care Multiple Choice 4/4 (100%)

Plan of Care Open Response 5/5 (100%)

0 1 2 3 4 5

41/50 points 82% Patient Score

Last attempt 54m Time Spent

Complete 100% Completion

Attempt completed at July 21, 2025 at 20:03 (UTC). Report generated on July 21, 2025 at 20:03 (UTC).

Scores shown and rationales provided are based on most recent attempt.

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Previous Attempt(s)

Attempt Start Date Completion Time Spent Total Score

#1 2025-07-21, 08:03 100% 54m 32/50 (64%)

1

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Alignment to Competencies

AACN Essentials The simulation meets the following domains from the AACN Essentials:

KNOWLEDGE FOR NURSING PRACTICE

VIEW DOMAIN 1

PERSON-CENTERED CARE

VIEW DOMAIN 2

PROFESSIONALISM

VIEW DOMAIN 9

Portions of these materials are taken from The Essentials: Core Competencies for Nursing Education. (“The Essentials”), which is

owned by the American Association of Colleges of Nursing (“AACN”). Any licensing of The Essentials by AACN does not constitute

or imply any endorsement of any company and/or any of its products, services, or written work product. Click here to read the

full disclaimer.

NCSBN Clinical Judgment Measurement Model

Each section maps to the NCSBN Clinical Judgment Measurement Model (NCJMM). On the last page of this report, Evaluate Outcomes using the EMPOWER® Debrief.

Recognize Cues

Analyze Cues

Prioritize Hypotheses

Generate Solutions

Take Action

Evaluate Outcomes

N/A N/A N/A N/A N/A N/A

Mapped to 0 Knowledge

Checks

Mapped to 0 Knowledge

Checks

Mapped to 0 Knowledge

Checks

Mapped to 0 Knowledge

Checks

Mapped to 0 Knowledge

Checks

Mapped to 0 Knowledge

Checks

2

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Alignment to Competencies

NCLEX Client Needs Categories

Interventions made in this simulation are mapped to one or more Client Needs Categories.

A

N/A

A. Safe and Effective Care Environment

Management of Care

0 actions map to this subcategory.

N/A

A. Safe and Effective Care Environment

Safety and Infection Control

0 actions map to this subcategory.

D

N/A

D. Physiological Integrity

Basic Care and Comfort

0 actions map to this subcategory.

N/A

D. Physiological Integrity

Pharmacological and Parenteral Therapies

0 actions map to this subcategory.

N/A

D. Physiological Integrity

Reduction of Risk Potential

0 actions map to this subcategory.

N/A

D. Physiological Integrity

Physiologic Adaptation

0 actions map to this subcategory.

B N/A

B. Health Promotion and Maintenance

0 actions map to this subcategory.

C N/A

C. Psychosocial Integrity

0 actions map to this subcategory.

3

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Score by Section

Vitals/Health History Multiple Choice

Considering the client’s history of a separation from her marriage and presenting with fatigue, what should be the nurse's priority nursing action?

Score

Correct

Assess the client's emotional well-being and explore feelings related to the separation

Given the recent separation and the potential impact on emotional health, addressing the client's feelings and providing emotional support is a priority (Maisel et al., 2021).

4/4

Inquiry Transcript

What brings you in today? I am tired and don’t want to do anything.

When did your symptoms start?

My husband of 38 years told me a couple of months ago that he wanted a divorce and that he has had a girlfriend for the last couple of years. He blames me for it. He says that I’m not fun to be around anymore because in the last few years I don’t want to do stuff that we used to do.

Does he still live at home? No. He left three weeks ago and since then I can’t stop crying. I feel like life is over for me. I wake up at all times of the night, crying, scared, and sometimes shaking.

Have you felt like this before?

When I was around 40 years old. I felt less energetic and would have crying episodes. It didn’t last long, and I was able to get out of it and move on. However, six years ago after my youngest son left home to go to college, I got very sad and unmotivated. Didn’t want to do much of anything.

Have you spoken with anyone about how you are currently feeling?

Yes, a few months ago. I went to see a therapist for a few sessions, and she referred me to a psychiatrist who prescribed venlafaxine for me.

Are you still taking the medication?

No. I stopped recently because I felt good, but it was so hard to get off of it. I felt like I had buzzing in my head.

Have you ever attempted suicide or had suicidal or homicidal thoughts, plans, or intent? Do you have thoughts of hurting yourself or others?

No. I go to church every Sunday. They help me. I also have a great and supportive extended family, and I have three children: Everett is 30, Josiah is 25, and Nia is 19.

4

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

So, how are you feeling in the last few weeks?

I have been feeling very sad and unmotivated. I don’t want to do anything other than stay in bed all day. I want to sleep, but I can’t. I wake up with anxiety in the middle of the night and worry about my future. I’ve been crying. I lost 10 pounds in the last few weeks – I don’t have the appetite that I used to have.

Do you work? No, I retired last year from the post office after 35 years.

What medical history do you have?

Hypertension.

Do you have any surgical history? Hysterectomy in 2015.

Do you take any medications both prescribed and over the counter?

Lisinopril 20mg and hydrochlorothiazide 25mg every morning.

Do you use any holistic medical practices such as essential oils or acupuncture?

Nia has gotten into yoga and meditation and has asked me to come to class with her, but I am too old for all that.

Do you have any family history of medical or psychiatric problems?

My mother died at age 73. She had depression and high blood pressure which gave her a stroke. My father died at 85, he had high blood pressure too. Both my older sister and younger brother have high blood pressure. My sister also has diabetes and my brother has depression. My oldest had some real sad times when he was in college but seems to be doing better now. My other two are in good health.

Tell me about your parents and siblings and your relationship with them.

My parents were married until Mom died. Both worked very hard. They really loved me and my siblings. We were a very close family and we still get together every weekend for Sunday dinner.

Any history of abuse or trauma? No.

Who do you live with? Alone since my husband left.

Do you exercise? Have hobbies? I used to walk around the block. Nothing in the last few weeks. No hobbies.

Any history of arrests or Convictions? Or any other legal issues?

No.

Do you smoke, use of alcohol, or any illicit drugs?

I have never smoked or done drugs. I do enjoy a good glass of wine. Charles, my husband, used to take me on wine tasting adventures.

How are your sleep and appetite? Poor sleep and poor appetite. I have lost 10 pounds in the last few weeks.

Inquiry Section Subjective Data

Chief Complaint (CC)

5

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

History of Present Illness (HPI)

Past Medical History (PMH)

Past Surgical History (PSH)

Health Practices/Preventative Health

Family Medical History (FMH)

Psychosocial Habits

Medications

Inquiry Multiple Choice

Which statement is true regarding family history as a potential risk factor of depression? Score

Correct

A family history of depression is a significant risk factor, along with individual circumstances and recent life events.

Family history is an important consideration, along with reviewing individual circumstances and recent life events to understand the individual’s overall risk of depression (Chand & Arif, 2023; Nichol et al., 2023).

4/4

ROS Multiple Choice

In the review of systems of a client presenting with depression, where are changes in appetite, fatigue, sleep disturbances, and feelings of sadness often discovered?

Score

Correct

Psychiatric Changes in appetite, fatigue, sleep disturbances, and feelings of sadness are related to the psychiatric system, specifically emotional well-being, mood, and overall mental health (Chand & Arif, 2023).

4/4

6

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Assessment Text Response

Given the initial assessment of Ivy Jackson, a 61-year-old female presenting with no acute distress but reporting feelings of sadness and lack of motivation, why is it important for the nurse to conduct a thorough mental status examination, including a detailed suicidal risk assessment?

Learner Response: it is important for the nurse to complete a full mental status exam and suicide risk assessment fo Ivy Jackson, a

61 year old woman reporting sadness and lack of motivation. even if she seems stable, this symptoms may point to depression,

which can be serious in older adults. many do not openly talk about sucidal thoughts, so asking directly is key. this assessment helps

the nurse understand Ivy mental health and insures she receives the right care and support.

Learner Reference(s): American Psychiatric Association. (2022). Practice guideline for the treatment of patients with major depressive disorder (3rd ed.). https://www.psychiatry.org

Feedback: Your response recognizes the significance of conducting a mental status examination and a suicide risk assessment for Ivy

Jackson, especially in the context of her reported sadness and lack of motivation. You highlight the potential for underlying

depressive symptoms and correctly note that older adults might not openly discuss suicidal thoughts, which is an important aspect

of care. However, there are areas for improvement, such as the depth of your reasoning regarding the connection between her

symptoms and the risk of depression—more explicit links to psychodynamic or epidemiological factors would enhance your

response. Additionally, try to use more precise language and avoid grammatical errors, as terms should be capitalized and phrasing

made clearer. Overall, integrating a more structured analysis and detailed understanding of Ivy's context could significantly

strengthen your answer.

Score: 4/5

7

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Assessment Multiple Choice

Considering Ivy’s specific age group, which is true of the pathophysiological relationship between depression and menopause?

Score

Incorrect

Over the age of 60, hormonal changes related to menopause continue to play a significant role in the development of depression

Hormonal changes associated with the perimenopausal stage typically occur around the age of 50. The impact of hormonal changes related to menopause on depression have likely diminished for women 60 years and older (Peacock et al., 2023).

0/4

Missed:

Hormonal changes related to menopause have a lesser impact on mental health at age 61 and other factors become more prominent

Hormonal changes have less influence on mental health in the post-menopausal stage, where other factors such as social, age, and health related considerations could become more common (Koothirezhi & Ranganathan, 2023).

--

Diagnostics Interpretation

Diagnostic Test Interpretation

CMP

Full Thyroid Panel (TSH, TT3, FT4)

CBC w/Differentials

Vitamin D

No Further Testing Required

8

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Diagnostics Text Response

Why is it clinically relevant to include Vitamin D and TSH levels in the laboratory workup when evaluating a client for depression, and how can the results of these tests influence the diagnosis and management of depressive symptoms?

Learner Response: It is important to check vitamin D and TSH levels when evaluating a client for depression because low levels can

cause or worsen symptoms. a vitamin D deficiency may lead to low energy and sadness, while thyroid problems, especially

hypothioridism, can mimic depression. If either is founf to be off, treating the medical issue can help improve mood without needing

psychiatric medications right away. this tests help guide proper diagnosis and support the best treatment plan.

Learner Reference(s): National Institutes of Health. (2022). Vitamin D: Fact sheet for health professionals. https://ods.od.nih.gov/ factsheets/VitaminD-HealthProfessional/

Feedback: Your response recognizes the significance of checking Vitamin D and TSH levels in the context of depression, connecting

deficiencies to mood symptoms. However, the clinical accuracy could be enhanced; for example, while you mention low energy and

sadness in relation to Vitamin D deficiency, it would have been beneficial to elaborate on its role in neurotransmission and brain

function. Your reasoning shows a basic understanding of how thyroid issues can mimic depression, but lacks specific detail about

how thyroid dysfunction affects treatment decisions for antidepressants. Additionally, there are typographical errors such as

“hypothioridism” and “founf” which detract from the professionalism of your terminology. To improve, strive to provide a more

detailed explanation of the biological mechanisms involved and ensure precision in language. Focusing on these aspects will

strengthen both your clinical reasoning and the overall clarity of your response.

Score: 4/5

9

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Final Diagnosis

Primary Diagnosis Secondary Diagnosis

Major depressive disorder No secondary diagnosis

Final Diagnosis Text Response

How does major depressive disorder (MDD) differ from situational depression in terms of etiology, symptomatology, diagnostic criteria, treatment approaches, and prognosis?

Learner Response: Major depressive disorder (MDD) and situational depression differ in cost, severity and duration. MDD may

occur without a clear reason and includes intense, lasting symptoms like sadness hopelesness, and lack of interest. situational

depression is triggeret by specific life event, such as lost or stress, or a big change. and is usually shorter and milder. MDD often

needs long term treatment with therapy and medication . Situational depression often improves with short term support and stress

management.

Learner Reference(s): National Institutes of Health. (2022). Vitamin D: Fact sheet for health professionals. https://ods.od.nih.gov/ factsheets/VitaminD-HealthProfessional/

Feedback: Your response identifies key differences between major depressive disorder (MDD) and situational depression, such as

the impact of life events and the severity of symptoms. However, the terminology used, such as "cost," is not relevant to a clinical

comparison of these conditions. Additionally, while you mention the duration and treatment approaches, your reasoning lacks

depth; you do not discuss diagnostic criteria or provide detailed insights into the underlying biological or psychological factors

associated with MDD. To improve, focus on accurately defining both conditions, their diagnostic criteria, and the comprehensive

range of treatment options available for MDD, including the potential need for medication and therapy. Additionally, ensure that

your response uses clinically appropriate terminology and fully expands on nuances that distinguish these two forms of depression.

Score: 3/5

10

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Plan of Care

Medication Text Response

Ivy Jackson was prescribed escitalopram for her depression. What type of drug is this, and what is the mechanism of action?

Learner Response: Escitalopram is a medicine called an SSRI, or selective serotonin reuptake inhibitor. it helps treat depression by

increasing the amoint of serotonin, a chemical in the brain that affects mood. escitalopram works by blocking the reabsorption of

serotonin in to brain cells, making more serotonin available to transmit messages between brain cells. This helps improve mood and

reduce depression symptoms. It is commonly prescribe because it works well and usually causes fewer side effects than other anti-

depressants.

Learner Reference(s): American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR).

Feedback: Your response accurately identifies escitalopram as an SSRI and explains its role in treating depression through increasing

serotonin levels. However, there are minor inaccuracies and areas needing improvement. Firstly, the sentence beginning with "it

helps treat depression" should start with a capital letter for proper structure. Additionally, the term "amoint" is a typographical error

that affects clarity. While you mention that escitalopram works by blocking the reabsorption of serotonin, the explanation could be

refined further with clearer terminology regarding "reuptake" rather than "reabsorption." Furthermore, while you note that it is

commonly prescribed and often leads to fewer side effects, a deeper exploration into why it is favored over other antidepressants

could enhance your reasoning. Focus on providing comprehensive explanations and ensuring grammatical accuracy to strengthen

your responses.

Score: 5/5

11

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Patient Education Text Response

What factors influence client adherence to SSRI medications like escitalopram in the treatment of major depressive disorder, and how can nurses effectively address these factors to improve treatment outcomes?

Learner Response: Many factors affect how well clients stick to taking SSRIs like ecitalopram. side effects, delay results, stigma,

forgetfulness, cost, and fear of dependence can all lead to stopping the medication early. Nurses can help by educating clients,

setting realistic expectations, offering reminders and providing emotional support. Regular follow up and involving family when

appropriate can also improve adherense. By addressing this issues, nunrses play a key role in improving treatment success and

helping clients feel better.

Learner Reference(s): American Psychiatric Association. (2022). Practice guideline for the treatment of patients with major depressive disorder (3rd ed.).

Feedback: Your response identifies several key factors that influence adherence to SSRIs, including side effects, delayed results,

stigma, forgetfulness, cost, and fear of dependence, which is commendable. However, while you list these factors, the depth of your

reasoning could be improved, particularly regarding the implications of fear of dependence and how stigma specifically affects the

patient's willingness to take medication. There are also minor spelling and grammatical errors present, such as "ecitalopram" and

"adherense" which detract from the overall professionalism of your response. For improvement, ensure to elaborate on how each

factor specifically impacts Ivy Jackson's case, considering her history of depression and experience with medication, as well as

providing clearer connections regarding how nurses can implement your suggestions. Addressing clarity and precision in terminology

will enhance your communication.

Score: 4/5

Plan of Care Knowledge Check

Which statement by Ivy suggests understanding of the plan of care? Score

Correct

"I'll attend counseling sessions to talk about my feelings and work through my struggles."

Ivy's commitment to attending counseling sessions reflects a proactive approach to dealing with emotional struggles. This indicates a deeper understanding of the holistic nature of healthcare, encompassing both physical and mental aspects (Bains et al., 2023).

4/4

12

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Final Plan of Care Text Response

Ivy Jackson, who is diagnosed with major depressive disorder and is on pharmacologic management with escitalopram, is also referred for individual therapy. What are some forms of individual therapy that can be beneficial as adjunctive treatments?

Learner Response: For Ivy Jackson, individual therapy can support her treatment with escitalopram for major depressive disorder.

Helpful therapy options include cognitive behavioral therapy (CBT) to change negative thoughts, inter personal therapy (IPT) to

improve relationships, and psychodynamic therapy to explore past experiences. Behavioral activation encourages positive activities,

and mindfulness base therapy helps prevent relapse. This therapies can reduce symptoms, improve coping skills, and support long

term recovery when used along with medication. A therapist can choose the best fit for her needs.

Learner Reference(s): American Psychological Association. (2017). Clinical practice guideline for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline

Feedback: Your response effectively identifies several forms of individual therapy that can be beneficial for Ivy's treatment, such as

cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT), demonstrating a solid understanding of adjunctive treatments

for major depressive disorder. However, it would benefit from stronger detail regarding the specific mechanisms by which these

therapies address Ivy's presenting issues, particularly her recent emotional distress stemming from her marital situation. While you

mention behavioral activation and mindfulness-based therapy (MBCT), be certain to use precise terminology, such as "mindfulness-

based cognitive therapy," to enhance clarity. Additionally, it may help to reference Ivy's psychosocial context, such as her recent

separation and the loss of motivation, to provide a more tailored and comprehensive therapeutic insight. Consider elaborating on

the support these therapies provide to enhance both emotional and functional aspects of her recovery.

Score: 5/5

13

Andres Munoz

AutoGen_cd8780f6-de7e-48ec-b14f- [email protected]

Capella University

Readiness Essentials: Ivy Jackson

Patient Summary

Final Score 41/50 (82%)

Outcomes

Ivy returned for a medication management follow-up 2 weeks after starting escitalopram 10 mg. She tolerates the medication well and denies any side effects. Minimal improvement with mood. Sleep improved with some use of melatonin. Appetite without a change. Motivation is still low but getting out of bed more. She has not made an appointment for individual therapy yet but has begun meditation class with her daughter. Reviewed treatment and she agreed to continue with escitalopram 10 mg every morning and melatonin as needed for sleep. Denies suicidal or homicidal ideations, plan, or intent. Agreed to go to Emergency Department or call 911 if in imminent situation.

Resources

Click here to view all references and resources used in this simulation.

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