★Safe & Effective Care Environment · 15–21% of the exam
Management of Care
Module 2 of 9 · Free NCLEX Prep Course · The RN Network
The largest single category on the NCLEX. Management of Care tests whether you can direct traffic safely: who does what, who is seen first, what is legal, and how care moves across the team.
Delegation and Supervision
The five rights of delegation: right task, right circumstance, right person, right direction/communication, right supervision/evaluation.
Delegate to UAP: ADLs, hygiene, ambulation of stable clients, vital signs on stable clients, I&O measurement, turning/repositioning, feeding clients without swallowing precautions.
Delegate to LPN/LVN: care of stable clients, medication administration (oral, SQ, IM; IV varies by state), reinforcing teaching the RN initiated, sterile dressing changes, tube feeding for established tubes.
Keep for the RN: initial and ongoing assessment, care planning, teaching, evaluation, IV push medications, blood products, unstable clients, and anything requiring clinical judgment.
When supervising delegated work, the RN verifies completion and evaluates outcomes — accountability is retained even when the task is transferred.
Prioritization and Triage
Emergency department triage: emergent (threat to life/limb — chest pain, airway compromise, active hemorrhage), urgent (needs care within hours — stable fracture, persistent vomiting), non-urgent (rash, sprain, medication refill).
Disaster/mass-casualty triage flips the logic: care goes to those most likely to survive with intervention. Clients with catastrophic injuries and minimal survival odds are triaged expectant (black tag).
On the unit, see first: airway/breathing compromise, hemodynamic instability, acute neurological changes, new-onset chest pain, and any sudden unexpected change.
A client who becomes suddenly quiet after being agitated, or whose respiratory rate is slowing after tachypnea, may be decompensating — trending matters more than single values.
When two clients are both unstable, choose the one whose problem is most immediately lethal and most fixable by nursing action.
Legal and Ethical Practice
Informed consent is obtained by the provider performing the procedure; the nurse witnesses the signature, verifies the client is competent and unmedicated by sedating drugs, and advocates if understanding is lacking.
Emancipated minors, and minors seeking care for pregnancy, STIs, or substance use (state-dependent), may consent for themselves. In a life-threatening emergency, consent is implied.
Advance directives: a living will states treatment wishes; a durable power of attorney for healthcare names a decision-maker. A DNR must be an active provider order — family wishes alone do not change code status.
Confidentiality (HIPAA): share information only with those directly involved in care. No hallway conversations, no information to callers without client authorization, no accessing charts out of curiosity.
Torts to know: assault (threat), battery (touching without consent), false imprisonment (unauthorized restraint), negligence (breach of duty causing harm), malpractice (professional negligence). Restraining a competent client who refuses care is false imprisonment.
Ethical principles: autonomy (client's right to decide), beneficence (do good), nonmaleficence (do no harm), justice (fairness), fidelity (keep promises), veracity (truthfulness). A competent adult may refuse any treatment — even life-sustaining treatment.
Care Coordination and Continuity
Use SBAR (Situation, Background, Assessment, Recommendation) for handoffs and provider calls; read back verbal and telephone orders.
Referrals: PT for mobility/strength, OT for ADLs and fine motor, speech-language pathology for swallowing and communication, social work for finances/placement/resources, case management for the discharge plan across settings.
Discharge planning starts at admission. Confirm the client can obtain medications, perform self-care, and state follow-up plans before discharge — teach-back verifies understanding.
Interdisciplinary conflict about client care goes up the chain of command: charge nurse → nursing supervisor — after direct, respectful communication with the provider fails.
Continuity items on NGN often hinge on what is missing from a handoff — scan for unreported abnormal findings.
Quality, Safety, and Incident Reporting
Complete an incident/occurrence report for errors, near-misses, falls, and equipment failures. Document facts objectively in the chart, but never chart that an incident report was completed — the report itself is an internal QI tool.
National Patient Safety Goals themes: two client identifiers before any care, medication reconciliation at every transition, marking surgical sites, time-outs before procedures, fall risk assessment, and clear alarm management.
Root cause analysis looks for system causes, not individual blame; a just culture separates human error from reckless behavior.
Report unsafe practice by a colleague (impairment, diversion, practicing beyond scope) to the charge nurse/supervisor immediately — client safety outranks collegial loyalty.
Never accept an assignment you are not competent to perform; communicate the limitation and negotiate a safe assignment rather than abandoning the shift.
Practice Questions
Answer each question, then read the rationale — the rationale is where the learning happens.
1.The RN is working with an LPN and a UAP. Which set of tasks is correctly assigned?
Rationale: A sterile dressing change on a stable client is within LPN scope, and ambulating a stable post-op client is within UAP scope. Initial assessments and discharge teaching are RN-only; IV push opioids are outside LPN scope in most states; clients with dysphagia should not be fed by UAP.
2.During a mass-casualty event, which victim should be triaged with a black (expectant) tag?
Rationale: In disaster triage, resources go to those most likely to survive. Agonal respirations with 95% full-thickness burns indicate minimal survival probability — expectant (black). The chest wound is immediate (red), the fracture is delayed (yellow), the ambulatory victim is minimal (green).
3.A competent adult client with a bowel obstruction refuses placement of a nasogastric tube. What is the nurse's BEST action?
Rationale: Autonomy: a competent adult may refuse any treatment. The nurse assesses the reason, ensures the refusal is informed, documents, and notifies the provider. Inserting anyway is battery; pressuring via family or threats is coercion.
4.The nurse finds a client on the floor beside the bed. After assessing and assisting the client, which action regarding documentation is correct?
Rationale: The medical record gets the objective facts (found on floor, assessment findings, provider notified). The incident report is a separate internal quality tool and is never referenced in the chart — referencing it destroys its legal protection.
5.A client scheduled for surgery received morphine 4 mg IV 30 minutes ago. The surgeon arrives to obtain informed consent. What should the nurse do?
Rationale: Consent requires an unimpaired decision-maker. A client medicated with IV opioids 30 minutes prior cannot give valid consent. The spouse cannot substitute for a client who is expected to regain capacity, and nurses never obtain surgical consent — the provider does.
6.The nurse suspects a coworker is diverting opioids and appears impaired during the shift. What is the priority action?
Rationale: An impaired nurse is an immediate client safety threat. Report up the chain of command now — the supervisor removes the nurse from care and initiates the required process. Private confrontation, informal warnings, or waiting all leave clients at risk.