NCLEX-RN, Medical exams, 15–21%

Management of Care

The highest-weighted subcategory of Safe and Effective Care Environment. It covers providing and directing nursing care: prioritizing clients, assigning and delegating, advocacy, informed consent, confidentiality, ethics and legal rights, and collaboration with the interprofessional team.

Position: 1 of 8 client needs categories
Published weighting: 15–21% in the official framework
Topics covered: 5 topics in this guide

What is covered

Topics inside this client needs category.

These topics describe the scope students most often review for this part of NCLEX-RN. Treat them as a study checklist rather than an exhaustive list of what a single exam form can sample.

Prioritization: Which client to see first and which action comes first, using airway, breathing, circulation, acute over chronic, and unstable over stable.
Assignment, delegation, and supervision: What may go to a licensed practical nurse or assistive personnel and what stays with the registered nurse: assessment, teaching, and evaluation.
Client rights and advocacy: Informed consent, advance directives, the right to refuse care, and speaking up for the client.
Legal and ethical practice: Confidentiality and privacy, scope of practice, reporting duties, and ethical principles such as autonomy and beneficence.
Collaboration and continuity of care: Handoff report, referrals, case management, and working with the interprofessional team.

Study tips

How to practice Management of Care.

Section-specific guidance that follows from how this material is usually tested.

Practice saying why each option is or is not the first priority; the reason matters more than the answer.
Learn delegation rules as what never leaves the registered nurse: initial assessment, teaching, evaluation, and an unstable client.
Give this category the largest share of review time; the test plan weights it highest.

Where this fits

Management of Care is 1 of 8 client needs categories in the NCLEX-RN guide, and it carries a published weighting of 15–21% in the official framework. Use the full guide to balance it against everything else you have to review.

Back to the NCLEX-RN guide Official exam information

Sample Management of Care questions

Practice questions, not yet expert-reviewed

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

Question 1Foundational
Which task may a registered nurse delegate to assistive personnel?
1. AEvaluating a client's response to pain medication
2. BMeasuring and recording vital signs of a stable client
3. CPerforming the admission assessment of a new client
4. DTeaching a client how to use an insulin pen
Show answer
Answer: B. Measuring and recording vital signs of a stable client
Assistive personnel may perform routine, standardized tasks for stable clients, such as measuring vital signs. Assessment, teaching, and evaluation require nursing judgment and stay with the registered nurse.
Key insight: Never delegate assessment, teaching, or evaluation to assistive personnel.
Question 2Intermediate
After receiving report, which client should the nurse assess first: one with COPD and a pulse oximetry reading of 90%, one two days after surgery with incisional pain of 5 out of 10, one with new restlessness and a respiratory rate of 30 after a femur fracture, or one with diabetes whose breakfast glucose was 180 mg/dL?
1. AThe client with new restlessness and rapid breathing after a femur fracture
2. BThe client with COPD and a saturation of 90%
3. CThe client with incisional pain of 5 out of 10
4. DThe client with diabetes and a glucose of 180 mg/dL
Show answer
Answer: A. The client with new restlessness and rapid breathing after a femur fracture
New restlessness and tachypnea after a long-bone fracture suggest fat embolism or pulmonary embolism, an acute and unstable breathing problem. A saturation near 90% is often the expected baseline in COPD, and moderate pain and mild hyperglycemia can wait.
Key insight: An acute change in breathing comes before an expected chronic finding.
Question 3Foundational
Who is responsible for explaining a surgical procedure's risks, benefits, and alternatives when obtaining informed consent?
1. AThe registered nurse caring for the client
2. BThe client's nearest relative
3. CThe hospital's risk manager
4. DThe health care provider performing the procedure
Show answer
Answer: D. The health care provider performing the procedure
The provider performing the procedure explains it and obtains consent. The nurse may witness the client's signature and confirm the client understands, and notifies the provider if the client has questions or seems not to understand.
Key insight: The provider explains; the nurse witnesses and checks understanding.
Question 4Intermediate
A client's spouse calls the unit and asks for the client's test results. What should the nurse do?
1. ATell the spouse to ask the health care provider for the results
2. BRead the results aloud but leave out any diagnosis
3. CConfirm the client has authorized sharing information with the spouse before giving any
4. DGive the results because spouses are legal next of kin
Show answer
Answer: C. Confirm the client has authorized sharing information with the spouse before giving any
Health information may be shared only with people the client has authorized. Being a spouse does not by itself give a right to the information, so the nurse checks the client's authorization first.
Key insight: Privacy follows the client's permission, not family relationships.
Question 5Advanced
Which client is most appropriate to assign to a licensed practical nurse?
1. AA client receiving a blood transfusion that started ten minutes ago
2. BA client with a stable chronic condition who needs scheduled oral medications
3. CA client admitted an hour ago with chest pain
4. DA client who needs discharge teaching about a new anticoagulant
Show answer
Answer: B. A client with a stable chronic condition who needs scheduled oral medications
Licensed practical nurses care for stable clients with predictable outcomes, including giving scheduled oral medications. New admissions, initial teaching, and the first minutes of a transfusion, when reactions are most likely, need the registered nurse.
Key insight: Give the licensed practical nurse stable clients with predictable care.

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Management of Care