Chapter 4 of 415% of exam

Evaluate: Monitoring Outcomes and Modifying the Plan

Evaluate is the smallest domain, but it asks the question that follows every plan: is it working, and what should change? Items test follow-up timing, what to monitor for a given drug, and when to step up, step down, hospitalize, or refer. The best answer usually rests on a specific interval or threshold from the guideline.

What the domain covers

The NPCB exam page lists two Evaluate tasks: evaluating the effectiveness of the plan of care, and monitoring and modifying the plan based on patient outcomes. (The PDF handbook's Evaluate list repeats the Plan task list, while the NPCB web page gives the two evaluation tasks.) In practice this means knowing when to recheck, what result counts as failure, and what to change.

Two Evaluate tasks
Evaluate the effectiveness of the plan of care; monitor and modify it based on outcomes.
NPCB FNP exam page, Domains and Tasks
Check the basics before escalating
Before stepping up asthma treatment, check inhaler technique and adherence first.
GINA 2026 Summary Guide
Deintensify when harm exceeds benefit
In older adults with hypoglycemia, reduce or stop sulfonylureas or insulin and use less stringent goals such as A1C below 8.0% for complex health.
ADA Standards of Care in Diabetes-2026, Sections 6 and 13

Follow-up after STI treatment

The STI guidelines separate a test of cure, which checks whether treatment worked, from retesting, which looks for reinfection. Most treated infections need retesting at about 3 months, and only specific situations need a test of cure.

Chlamydia
No test of cure for nonpregnant patients on a recommended regimen; retest about 3 months after treatment. In pregnancy, test of cure at about 4 weeks.
CDC STI Treatment Guidelines 2021
Gonorrhea and trichomoniasis
Pharyngeal gonorrhea needs a test of cure 7-14 days after treatment; retest after gonorrhea and after trichomoniasis in women at about 3 months.
CDC STI Treatment Guidelines 2021
Syphilis
Clinical and serologic follow-up at 6 and 12 months, comparing nontreponemal titers with the titer at treatment.
CDC STI Treatment Guidelines 2021
PID
Expect improvement within 72 hours of outpatient therapy; otherwise hospitalize and reassess the diagnosis and regimen.
CDC STI Treatment Guidelines 2021

Monitoring chronic disease and drug therapy

Monitoring intervals come from the guideline for each condition and drug. Questions often pair a drug with the laboratory value it can disturb, or pair a result with the next step when the goal is not met.

Glycemic monitoring
Check A1C at least twice a year when goals are met and about every 3 months when they are not or therapy has changed.
ADA Standards of Care in Diabetes-2026, Rec. 6.2
Lipids and electrolytes
Recheck lipids 4-12 weeks after starting a statin; check potassium 7-14 days after starting a diuretic; monitor eGFR and potassium with ACE inhibitors, ARBs, and MRAs.
ADA Standards of Care in Diabetes-2026, Section 10
Hypertension not at goal
At low PREVENT risk, start medication if blood pressure stays at or above 130/80 after 3-6 months of lifestyle change; in resistant hypertension, screen for primary aldosteronism regardless of potassium.
2025 AHA/ACC High Blood Pressure Guideline
Opioids and LTBI drugs
Reassess opioid benefit and harm within 1-4 weeks of starting or escalating; hold latent TB drugs if transaminases exceed 3 times normal with symptoms or 5 times normal without.
CDC Opioid Guideline 2022, Rec. 7; CDC Treatment for Latent TB Infection

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