Management of Care Questions
What It Tests
Management of Care is 15 to 21 percent of the exam, the largest category. NCSBN puts in it prioritization, delegation and assignment, advocacy, informed consent, confidentiality, client rights, ethics and legal responsibilities, and continuity of care. On screen the stem often has four clients instead of one, a team instead of a client, or no disease at all, and every option sounds like a reasonable nursing action.
Rule 1
See first the client who is unstable, acute, or changing, never the sickest on paper. The exam ranks by risk of deterioration right now, not by diagnosis or by who waited longest. Worked: "Four clients: day-two post-op pain 6 of 10; chronic COPD at 90%; new confusion after a fall this morning; a discharge asking about medications." → the new confusion is the change that started today; the other three are stable or expected.
Rule 2
Delegate only a predictable task on a stable client; assessment, teaching, evaluation, and every first time stay with the RN. Test the client first, then the task; who is free never enters into it. Worked: "Which task can go to assistive personnel: vital signs on a client one hour into a chest-pain admission, or a bath for a stable day-three client?" → the bath; the vital signs on an unstable client are an assessment.
Rule 3
The competent client decides; you carry out their wishes, and their information goes only to people caring for them. Advocacy means acting on the client's stated choice, and confidentiality means the neighbor, the roommate, and the relative who calls get nothing. Worked: "A competent client with a living will refuses a feeding tube; the family insists." → support the client's refusal.
What to Review
Clinical Pearl
Unstable first, delegate only the predictable on the stable, and the competent client decides.