Chapter 3 of 427% of exam

Plan: Treatment, Referral, Education and Prevention

Plan covers building a patient-centered, evidence-based plan: choosing drug and non-drug treatment, deciding when to refer or consult, and giving education and preventive care. Questions tend to ask for the first-line choice, the agent to avoid in a given patient, or the preventive service a patient qualifies for. Current guideline editions matter here, because first-line recommendations change.

What the domain covers

NPCB lists four Plan tasks: establish an evidence-based plan of care, initiate interprofessional referrals or consultations, prescribe or administer pharmacologic and non-pharmacologic treatment, and provide education, counseling, and health promotion. The knowledge areas include pharmacologic, non-pharmacologic, and integrative therapeutics, pain management, and therapeutic communication.

Four Plan tasks
Plan of care, referral or consultation, pharmacologic and non-pharmacologic treatment, and education and health promotion.
NPCB FNP Candidate Handbook (updated 06/2026), Appendix A
Confirm understanding
Use teach-back or show-me rather than asking whether the patient understands.
AHRQ PSNet, Health literacy
Preventive medication
Folic acid 0.4-0.8 mg daily before conception, low-dose aspirin after 12 weeks for high preeclampsia risk, and PrEP for people at increased HIV risk are USPSTF-recommended preventive medications.
USPSTF Folic Acid, 2023; Aspirin for Preeclampsia, 2021; HIV PrEP, 2023

Infections and antibiotic stewardship

Infectious disease questions reward knowing the recommended regimen and knowing when not to prescribe. CDC's STI guidelines changed several first-line regimens in 2021, and CDC's outpatient stewardship guidance lists which common infections should not get antibiotics at all.

STI regimens
Chlamydia: doxycycline for 7 days. Gonorrhea: ceftriaxone 500 mg IM once (under 150 kg). Primary syphilis: benzathine penicillin G 2.4 million units IM once. Trichomoniasis in women: metronidazole for 7 days.
CDC STI Treatment Guidelines 2021
Respiratory infections
Amoxicillin or penicillin for strep pharyngitis (10 days); amoxicillin for otitis media unless amoxicillin was used in the past 30 days; no antibiotics for colds or uncomplicated acute bronchitis.
CDC Outpatient Clinical Care for Adults and Pediatric Populations
Cystitis
Nitrofurantoin, fosfomycin, or TMP-SMX where local resistance is under 20% are first-line; reserve fluoroquinolones.
CDC Outpatient Clinical Care for Adults
Influenza
Start antivirals as soon as possible for higher-risk patients without waiting for test results; avoid inhaled zanamivir in asthma or COPD.
CDC Influenza Antiviral Medications: Summary for Clinicians

Chronic disease management

Chronic disease questions follow the current society guidelines: the 2025 AHA/ACC hypertension guideline, the ADA Standards of Care 2026, GOLD 2026 for COPD, and GINA 2026 for asthma. Comorbidities often decide the drug, as when heart failure calls for an SGLT2 inhibitor or possible pregnancy rules out an ACE inhibitor.

Hypertension
First-line classes are thiazide-type diuretics, long-acting dihydropyridine calcium channel blockers, and ACE inhibitors or ARBs; stage 2 usually starts with two drugs, preferably in one pill; the goal for most adults is below 130/80.
2025 AHA/ACC High Blood Pressure Guideline
Type 2 diabetes
Use an SGLT2 inhibitor in heart failure and a GLP-1 RA or SGLT2 inhibitor with proven benefit in ASCVD, regardless of A1C; consider insulin when A1C is above 10% or glucose is 300 or more with symptoms.
ADA Standards of Care in Diabetes-2026, Section 9
COPD
Start LABA plus LAMA in GOLD groups B and E; LABA plus ICS is not encouraged; long-term oxygen for resting PaO2 of 55 mm Hg or less.
GOLD 2026 Report
Asthma
Do not treat adults, adolescents, or children 6-11 with SABA alone; as-needed low-dose ICS-formoterol is GINA's preferred reliever for adults and adolescents.
GINA 2026 Summary Guide

Immunization, pain and behavioral health

Plan also covers vaccines for adults, pain treatment that limits opioid harm, and prevention-oriented counseling. The adult schedule and the CDC opioid guideline are organized around specific situations, so the details of the scenario decide the answer.

Adult vaccines
Recombinant zoster vaccine (2 doses) for adults 50 and older regardless of prior shingles; Tdap in each pregnancy at 27-36 weeks; tetanus booster after 5 years for wounds that are not clean and minor.
CDC Adult Immunization Schedule Notes, 2025
Acute and chronic pain
Prefer nonopioid therapy; if opioids are needed, use immediate-release forms at the lowest dose for the shortest expected duration, check the PDMP, and offer naloxone.
CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022
Opioid use disorder
Offer or arrange medication treatment; detoxification alone is not recommended.
CDC Opioid Prescribing Guideline 2022, Recommendation 12
Perinatal depression prevention
Provide or refer pregnant and postpartum people at increased risk to counseling such as cognitive behavioral or interpersonal therapy.
USPSTF Perinatal Depression: Preventive Interventions, 2019

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