NCLEX-RN · 15–21% of the exam
Who first, who does it, and is it allowed?
Management of Care is the largest content area on the NCLEX-RN. Most of its questions come down to three decisions: which client needs you first, who on the team should do the task, and whether the action is within the rules. Here's how to make each one.
Management of Care questions often feel like they have two right answers. Every option is something a nurse might reasonably do. The question is which comes first, or which is yours to do. That's why memorizing facts helps less here than in any other area, and why a few reliable decision rules help more.
01 / Scope
What Management of Care covers.
NCSBN defines it as "providing and directing nursing care that enhances the care delivery setting to protect the client and health care personnel." It makes up 15–21% of scored content items on the 2026 NCLEX-RN. The test plan's activity statements include:
- Prioritizing care based on acuity, and organizing your workload.
- Delegating and supervising care given by LPN/VNs, assistive personnel, and other RNs.
- Handoff, admission, transfer, and discharge.
- Receiving, verifying, and implementing provider orders.
- Advocacy, consent, and advance directives: client rights, informed consent for procedures, and integrating advance directives into the plan.
- Confidentiality, ethics, and legal scope: privacy (including social media), mandatory reporting, ethical dilemmas, and practicing within scope.
- Collaboration and referrals with the interprofessional team, plus quality improvement.
02 / Prioritization
Prioritization: who do you see first?
Prioritization items give you several clients, or several actions, and ask which comes first. Work through them in this order:
Unstable before stable
A client whose condition is changing, especially for the worse, comes before one whose findings are expected for their condition.
Airway, breathing, circulation
Among unstable clients, threats to airway, then breathing, then circulation come first.
Actual before potential
A problem happening now usually outranks a risk, unless the risk is severe and imminent.
Watch for the word "expected." A client two days after surgery with incision pain of 3/10 has an expected finding. A client whose oxygen saturation dropped in the last hour and who is newly restless has an unexpected change, and new restlessness can be an early sign of low oxygen. That client is first. This is the same reasoning as the vital signs trend in our clinical skills series.
03 / Delegation
Delegation: who should do it?
NCSBN's five rights of delegation are the frame for every delegation item: the right task, under the right circumstances, to the right person, with the right directions and communication, and with the right supervision and evaluation. Two points do most of the work on the exam:
- The client must be stable with predictable outcomes. If the client's condition is changing, the task stays with the RN.
- Clinical judgment can't be delegated. The RN keeps initial assessments (such as admission assessments), client teaching, care planning, and evaluation. Routine tasks for stable clients, such as vital signs, hygiene, and feeding a client without swallowing problems, can go to assistive personnel.
The RN who delegates stays accountable for the client; the person who accepts the task is responsible for doing it correctly. Exactly what an LPN/VN or assistive personnel may do varies by state and facility policy, so exam items stick to the clear-cut principles above.
04 / Rules
Orders, consent, and scope.
- Orders
- Verify that an order is complete and appropriate before carrying it out. If it isn't, clarify it with the provider. Don't carry it out and don't change it yourself.
- Consent
- The provider performing the procedure is responsible for explaining it and obtaining informed consent. The nurse may witness the signature, verifies that the client understands and agrees, and alerts the provider if the client doesn't understand or has unanswered questions.
- Advocacy
- When a client's wishes, rights, or safety are at stake, the nurse speaks up through the right channel: the provider, the charge nurse, then the chain of command.
- Handoff
- Structured handoff, such as SBAR, with a chance for questions. Most handoff items reward completeness and two-way communication.
05 / Practice
Practice questions.
These are original practice items written by NurseCaseLab, not real NCLEX items. Commit to an answer before reading the rationale.
The nurse receives handoff report on four clients. Which client should the nurse assess first?
- A. A client 2 days after hip replacement surgery who rates incision pain 3/10 and is asking for help to the bathroom
- B. A client with pneumonia whose SpO2 fell from 94% to 88% on 2 L/min in the last hour and who is newly restless
- C. A client with type 2 diabetes who is due for scheduled insulin, with a blood glucose of 156 mg/dL
- D. A client being discharged today who is waiting for discharge teaching
B is the only client with an unexpected, worsening change in breathing, and new restlessness may signal low oxygen. Breathing outranks the other needs. A has expected postoperative findings; C has a routine, scheduled task with a glucose that doesn't need urgent action; D is important but not time-critical.
Which task is appropriate for the RN to delegate to assistive personnel?
- A. Teaching a client how to use an incentive spirometer
- B. Completing the admission skin assessment on a newly admitted client
- C. Taking routine vital signs on a stable client 3 days after surgery
- D. Evaluating a client's response to a pain medication
Routine vital signs on a stable client fit the right task and the right circumstance. Teaching (A), initial assessment (B), and evaluation (D) all require nursing judgment and stay with the RN. The RN still reviews the vital signs the assistive personnel reports.
06 / Study plan
How to study Management of Care.
- Practice ranking, not recalling. Do multi-client prioritization items and say aloud why each client isn't first.
- Learn the "who can do it" boundaries using the five rights, and note your state's rules for LPN/VN practice.
- Read every option as an action. Ask: is this mine to do, is it safe, and is it the most urgent?
- Classify your misses. Most misses here are priority errors or scope errors, not knowledge gaps. See our clinical judgment guide for the classification.
Keep studying
Next content areas.
Practice under exam conditions
Practice prioritization in unfolding cases.
NursingProxy's NCLEX Simulation Lab uses unfolding clinical-judgment cases, with rationales that explain why an answer ranks by priority, timing, scope, or risk.
Explore the NCLEX Simulation Lab Relationship disclosure: NurseCaseLab and NursingProxy are related learning properties. This external resource is optional and isn't required to use this guide.Sources & further reading
Go to the source.
- NCSBN, 2026 NCLEX-RN Test Plan (PDF)
- Nursing Management and Professional Concepts (Open RN), 3.4 Delegation
- Nursing Fundamentals (Open RN), 2.4 Communicating with Health Care Team Members
- Medical-Surgical Nursing (OpenStax), 25.2 Preoperative Nursing Priorities: the nurse's role in informed consent
Practice questions are original NurseCaseLab items, not NCLEX items. NCLEX is a registered trademark of NCSBN; NurseCaseLab isn't affiliated with or endorsed by NCSBN. Delegation rules vary by state; follow your Nurse Practice Act and facility policy.