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NCLEX-RN category

NCLEX Management of Care Practice Questions

Quick answer

Management of Care is the largest category on the NCLEX-RN at 15 to 21% of the exam, which works out to roughly 13 to 31 questions. It covers how a nurse coordinates care, protects client rights, uses the team, and keeps the unit safe, not just what a nurse does at the bedside.

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Students tend to treat this category as "common sense" and then lose marks on it, because the exam is testing the nurse's role, not general good judgment. A question about a near miss is really asking whether you understand how a unit learns from errors. A question about a referral is asking whether you know what a social worker does that a nurse does not. The trap most people fall into is picking the option where the nurse personally fixes everything. On this section, the right answer often involves the right person, the right process, or the right document rather than the nurse acting alone. The ten questions below are pulled from across the category, outside the prioritization, delegation and ethics pages, which each have their own set.

Practice questions

1

A nurse is giving a handoff report using SBAR for a client admitted with pneumonia whose oxygen saturation has dropped from 95% to 89% over the shift. Which information belongs in the "R" part of the report?

  1. AThe client was admitted two days ago with right lower lobe pneumonia
  2. BOxygen saturation is now 89% on 2 liters by nasal cannula
  3. CThe oncoming nurse should obtain a repeat chest x-ray order and reassess within 30 minutes
  4. DThe client has a history of COPD and smokes a pack a day
Show answer

Answer: C

The R in SBAR stands for Recommendation, which is what the sender thinks should happen next. A request for a chest x-ray order and a timed reassessment is a recommendation.

Why the others are wrong

The admitting diagnosis and the smoking history are Background. The current oxygen saturation and oxygen flow are Assessment. All three belong in the report, just in different sections.

2

A 78 year old client who lives alone is recovering from a hip fracture repair. The client can walk 20 feet with a walker but cannot yet manage stairs, cook, or bathe without help. Which referral should the nurse request first to plan the client's care after discharge?

  1. AHospice
  2. BSocial work or case management
  3. CSpeech therapy
  4. DRespiratory therapy
Show answer

Answer: B

The client's problem is where and how they will live safely after discharge, which is exactly what case management and social work handle. They arrange rehab placement, home health, equipment and financial resources.

Why the others are wrong

Hospice is for clients with a terminal prognosis, and a hip fracture repair is not that. Speech therapy addresses swallowing and communication, which are not the concern here. Respiratory therapy has no role in this client's discharge barrier.

3

A client with a new stroke has right sided weakness, slurred speech, and coughs when drinking thin liquids. The nurse is coordinating the interprofessional team. Which team member should the nurse consult about the client's swallowing before the next meal?

  1. AOccupational therapist
  2. BPhysical therapist
  3. CSpeech-language pathologist
  4. DRegistered dietitian
Show answer

Answer: C

A speech-language pathologist evaluates swallowing and recommends diet texture and liquid thickness. Coughing with thin liquids is an aspiration warning sign, so the evaluation needs to happen before the client eats again.

Why the others are wrong

The occupational therapist works on self care tasks like feeding technique and dressing, not the swallow itself. The physical therapist works on mobility and transfers. The dietitian plans nutrition but acts on the swallow study results, not in place of it.

4

A competent adult client with chest pain refuses a cardiac catheterization after the cardiologist has explained the risks and benefits. The client's daughter asks the nurse to "just tell him he has to do it." What is the nurse's best response?

  1. ATell the client the procedure is required by hospital policy
  2. BAsk the daughter to sign the consent form on the client's behalf
  3. CMake sure the client understands the consequences of refusing, then support the decision and document it
  4. DSchedule the procedure and hope the client changes his mind
Show answer

Answer: C

A competent adult has the right to refuse any treatment, even one that could save his life. The nurse's role as advocate is to confirm the refusal is informed, support the client, and record the conversation.

Why the others are wrong

No policy can force a competent adult to accept a procedure. A family member cannot consent for a competent client. Scheduling against the client's stated wishes ignores the refusal and could amount to battery if the procedure went ahead.

5

A nurse nearly gives a client another client's morning medications but catches the error at the bedside when scanning the armband. No harm occurred. Which action by the nurse supports the unit's performance improvement process?

  1. ASay nothing, since the client was not harmed
  2. BComplete an incident report so the near miss can be reviewed for a root cause
  3. CDocument in the client's chart that an error almost happened
  4. DAsk the charge nurse to keep it off the record to avoid discipline
Show answer

Answer: B

Near misses are reported exactly like errors that reach the client, because they show where the system is weak. A root cause analysis looks at the process (two clients with similar names in adjoining rooms, for example) rather than blaming the nurse.

Why the others are wrong

Staying silent hides a system problem that could harm the next client. Incident reports are not part of the medical record, and the chart should only contain what actually happened to the client. Asking for it to be kept off the record defeats the point of a just culture.

6

The charge nurse on a medical unit is told that one RN called in sick for the night shift, leaving four RNs and two unlicensed assistive personnel for 28 clients. Which action should the charge nurse take first?

  1. AAsk each of the four RNs to take seven clients and carry on
  2. BReview the acuity of the 28 clients and notify the nursing supervisor of the staffing shortfall
  3. CTransfer the most stable clients to another unit
  4. DTell the unlicensed assistive personnel to take on medication passes for stable clients
Show answer

Answer: B

Resource management starts with knowing what the clients actually need tonight and then escalating the gap to the person who can send help, float a nurse, or approve agency staff. Acuity drives assignment, not head count.

Why the others are wrong

Dividing clients evenly ignores acuity and may leave one nurse with the sickest clients. Moving clients between units is not something a charge nurse decides alone and does not fix the shortage. Medication administration is outside the scope of unlicensed assistive personnel no matter how stable the client is.

7

A client with newly diagnosed heart failure is being discharged tomorrow. Which statement by the client tells the nurse that discharge teaching about when to call the provider was understood?

  1. A"I will call if I gain more than 2 to 3 pounds in a day or 5 pounds in a week."
  2. B"I will only call if I have chest pain, since swelling is normal with my condition."
  3. C"I should wait until my follow-up appointment to mention any shortness of breath."
  4. D"If my ankles swell I will skip my water pill so I do not have to get up at night."
Show answer

Answer: A

Rapid weight gain is the earliest sign of fluid retention in heart failure, and the client has repeated the standard threshold correctly. That is the point of discharge planning: the client knows what to watch for and when to act.

Why the others are wrong

Swelling and weight gain are warning signs, not something to accept. New shortness of breath should be reported right away, not saved for a visit. Skipping a diuretic because of edema is backwards and will make the fluid problem worse.

8

A nurse from the orthopedic unit is floated to the oncology unit for one shift. The oncology charge nurse is making assignments. Which action by the charge nurse is most appropriate?

  1. AGive the float nurse the client receiving a first dose of IV chemotherapy, since that client is otherwise stable
  2. BAsk the float nurse what skills and experience she has, then assign clients whose needs match them
  3. CAssign the float nurse the same number of clients as the regular staff to keep things fair
  4. DHave the float nurse only answer call lights and do vital signs for the shift
Show answer

Answer: B

A float nurse is still an RN, but she should only be assigned clients whose care falls within her competence. The charge nurse remains responsible for finding out what that is and for being available to supervise.

Why the others are wrong

Administering chemotherapy requires specific training that an orthopedic nurse is unlikely to have. Equal numbers are not the goal, safe matching is. Restricting an RN to assistive tasks wastes a licensed nurse and does not address the unit's actual needs.

9

A nurse is documenting in the electronic health record and realizes that a blood pressure entered an hour ago was typed into the wrong client's chart. What is the correct action?

  1. ADelete the entry so there is no trace of it
  2. BLeave the entry in place and add the correct value underneath it
  3. CFollow the facility process to mark the entry as entered in error, then document the value in the correct client's record
  4. DAsk a coworker with administrator access to remove the entry
Show answer

Answer: C

Electronic records keep an audit trail, so the proper fix is to flag the entry as an error through the system's correction function and then chart the value where it belongs. Both charts need to be accurate.

Why the others are wrong

Deleting or having someone else delete an entry is tampering with a legal record. Leaving a wrong vital sign in another client's chart could lead to a treatment decision based on bad data. Using someone else's login is a privacy and security violation.

10

Two nurses on the same shift have had an argument in the hallway about who should take the next admission. Clients and visitors could hear them. The charge nurse steps in. Which approach is the best first step in resolving the conflict?

  1. ATell both nurses to stop and assign the admission to whichever one has fewer clients
  2. BMove the conversation to a private area and have each nurse describe the problem from their point of view
  3. CReport both nurses to the nurse manager for unprofessional behavior
  4. DTake the admission herself so the argument ends
Show answer

Answer: B

Conflict resolution starts with getting the discussion out of public view and letting each person be heard. Once the real issue is on the table, the charge nurse can help them reach a solution they both accept.

Why the others are wrong

Ordering a solution ends the argument but not the conflict, and it will come back. Escalating to the manager as the first step skips the chance to settle it at the unit level. Taking the admission avoids the problem instead of resolving it, and teaches nothing about how to handle the next disagreement.

Quick tips

  • When a question asks who to involve, match the problem to the discipline: swallowing goes to speech, home setup goes to case management or social work, self care goes to occupational therapy, and mobility goes to physical therapy.
  • Near misses get reported the same way as errors. If an option hides, minimizes, or keeps something off the record, it is wrong.
  • A competent adult can refuse anything. Your job is to make sure the refusal is informed, then support and document it. Family members do not get to override that.
  • Float nurses and new staff are assigned by competence, not by numbers. The charge nurse stays responsible for supervision.
  • Never alter, delete, or share access to a client record. Every correction goes through the facility's error process so the audit trail stays intact.

Related topics

FAQ

How many management of care questions are on the NCLEX?

Management of Care is 15 to 21% of the exam. On an 85 question test that is about 13 to 18 questions, and on a 150 question test it can be closer to 31. It is the single largest category, so it is worth studying on its own.

What topics are in management of care on NCLEX?

Prioritization, delegation and supervision, ethics and legal issues, client rights and advocacy, informed consent, continuity of care and handoff, referrals and case management, collaboration with the interprofessional team, quality improvement, staffing, and information security and documentation.

Why do I keep getting management of care questions wrong?

Usually because you are answering as a person rather than as a nurse in a system. Ask yourself what the nurse's role is in the scenario, who else on the team owns part of the problem, and what process (incident report, consent, SBAR, referral) the question is really testing.

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