Chapter 1 of 715% of exam

Management of Care

Management of Care is the largest client-needs category on the NCLEX-RN and tests the registered nurse's ability to coordinate care, delegate appropriately, prioritize among clients, and protect client rights. Success requires applying frameworks such as ABC, Maslow's hierarchy, and the nursing process to decide who to see first and what to do next.

Prioritization Frameworks

When several clients or tasks compete for attention, the nurse uses structured frameworks rather than personal preference. The ABC (airway, breathing, circulation) framework identifies immediate physiological threats, while Maslow's hierarchy and the nursing process guide broader ranking of needs.

Apply ABC first

Address airway, then breathing, then circulation problems before other needs, because these threaten life most rapidly.

Use Maslow when no ABC threat exists

Meet physiological needs before safety, then love and belonging, esteem, and self-actualization.

Prioritize the unstable client

The least stable or most rapidly changing client is generally seen first.

Acute over chronic

A new, acute problem usually takes priority over a stable chronic condition.

Delegation and Assignment

The RN delegates tasks based on scope of practice, client stability, and staff competency. Assessment, teaching, evaluation, and clinical judgment cannot be delegated, and the RN retains accountability for outcomes.

Delegate routine tasks to UAP

Vital signs on stable clients, hygiene, ambulation, and intake and output are appropriate for unlicensed assistive personnel.

Reserve nursing judgment for the RN

Initial assessment, care planning, teaching, and evaluation stay with the registered nurse.

Match acuity to competency

Assign stable, predictable clients to less experienced staff and complex clients to experienced nurses.

Accountability is not transferred

Delegation moves the task, not the responsibility; the RN supervises and follows up.

Client Rights and Advocacy

The nurse advocates for clients and protects their legal and ethical rights, including autonomy, informed consent, and the right to refuse treatment. The nurse ensures consent is voluntary and informed and documents refusals appropriately.

Respect autonomy

Competent clients may accept or refuse treatment; document refusals and notify the provider.

Clarify consent roles

The provider explains risks and alternatives; the nurse witnesses that consent is voluntary and informed.

Advocate for the client

Speak up when a plan may harm the client or conflicts with the client's expressed wishes.

Protect confidentiality

Share protected health information only with those involved in the client's care.

Ethical and Legal Practice

Nurses apply ethical principles such as autonomy, beneficence, nonmaleficence, justice, and veracity, and follow legal standards for documentation and error reporting. Accurate charting and incident reporting support quality and safety.

Practice veracity

Document only care that was actually provided; falsification is an ethical and legal violation.

Report errors and near-misses

Complete an incident report for quality improvement; do not file it in the medical record.

Apply nonmaleficence

Avoid actions that could harm the client, and question unsafe orders.

Ensure justice

Distribute care and resources fairly regardless of the client's background.

Continuity and Coordination of Care

The nurse coordinates care across disciplines and settings through handoff communication, case management, and discharge planning. Clear communication reduces errors and readmissions.

Give structured handoff

Emphasize the least stable clients and use a consistent format to ensure continuity.

Plan discharge early

Arrange home health, equipment, and follow-up appointments before the client leaves.

Coordinate the team

Communicate with providers, therapists, and social workers to align the plan of care.

Reconcile medications

Verify the client's medication list at transitions to prevent omissions and duplications.

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Last updated: July 2026