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NCLEX Test Strategy · Topic 3 of 9

Management of Care Questions

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NCLEX strategy · Management of Care

Management of Care Questions

Management of Care is 15–21% of NCLEX-RN items, the largest patient-needs category. The answer protects the unstable patient, the RN's scope and the patient's own choices.

01 · See firstUnstable or new change beats worst diagnosis
02 · DelegationAP: routine tasks on stable patients only
03 · Patient rightsA competent adult decides, even against family
01

Who to see first

New and unexpected beats serious but stable

See the unstable or acute patient first
A new, unexpected change outranks an expected finding
The most serious diagnosis, stable and as expected, can wait
An abnormal value at the patient's chronic baseline is expected
02

RN keeps · delegate to AP

RN keeps

Assessment, teaching, evaluation and clinical judgment
A fresh post-op or newly admitted patient
A patient with unstable vital signs
The first walk after surgery

Delegate to assistive personnel (AP)

Routine, predictable tasks
On stable patients only
03

The five rights of delegation

Right task
Right circumstance
Right person
Right directions and communication
Right supervision and evaluation
04

Patient rights and consent

A competent adult decides — even refusing what the family wants
The nurse supports and advocates for the patient's stated choice
Current wishes override an advance directive and the family
The provider explains the procedure and obtains consent
The nurse witnesses the signature
Patient can't describe the procedure → notify the provider
05

Confidentiality

Share only with the care team or people the patient agrees to
Not authorized? Share nothing
Required reports need no authorization

Family and friends may also be told if the patient, given the chance, does not object. Required reports: abuse or neglect, reportable communicable diseases and court orders.

06

Real examples

Chronic COPD, SpO₂ about 90% → expected; see the new change first
Fresh post-op patient → the RN does this care, not the AP
First walk after surgery → the RN does it
Competent patient refuses what family wants → support the patient
Patient can't describe the surgery → notify the provider
Unauthorized family member calls → confirm nothing, even normal results
07

When the usual answer changes

Patient not stable → the task is not delegated to AP RN keeps it
Abuse, neglect, reportable disease, court order → report it no consent needed
Abnormal value at chronic baseline → not a new change ranks lower
08

See first or can wait?

Rank by stability and change, not by diagnosis

See firstCan wait
StatusUnstable or acuteStable
FindingA new, unexpected changeAs expected, or at the patient's chronic baseline
DiagnosisAny diagnosisEven the most serious diagnosis
09

On the exam

15–21% of NCLEX-RN items — the largest category (2026 test plan)

NCSBN content here: prioritizing by acuity, delegation and supervision, advocacy, patient rights, consent, advance directives, confidentiality, handoff, referrals, legal scope, ethics and mandatory reporting. The 2026 test plan took effect April 1, 2026; category percentages are unchanged from 2023.

Pearl

See the unstable or newly changed patient first, keep assessment with the RN, and let the competent patient decide.

Sources · 2026 NCLEX-RN Test Plan (NCSBN) · Nursing Management and Professional Concepts 2e, 2.3 Tools for Prioritizing (Open RN) · National Guidelines for Nursing Delegation (NCSBN) · Nursing Management and Professional Concepts, Ch. 3 Delegation and Supervision (Open RN, NCBI Bookshelf) · Fundamentals of Nursing 16.3 Legal Dimensions of Care (OpenStax) · 45 CFR 164.510 (Cornell LII) · 45 CFR 164.512 (Cornell LII) · Medical-Surgical Nursing 25.2 Preoperative Nursing Priorities (OpenStax) · Advance Directives (StatPearls) · Follow your state nurse practice act and agency policy for delegation.

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