Management of Care is the largest single area of the NCLEX — 15–21% of your exam. Its questions look chaotic (four patients, one nurse) but they're solved by a small set of frameworks applied in order. Here they are, with practice questions at the end.
Before ABCs, sort the options: unexpected beats expected, acute beats chronic, unstable beats stable. A COPD client with their usual morning oxygen saturation loses to a stable-appearing client with a brand-new finding every time. New chest pain beats chronic pain rated higher. Post-op day 0 beats post-op day 3.
Airway, then breathing, then circulation — unless: (1) in cardiac arrest the order is compressions first (C-A-B), and (2) catastrophic bleeding gets controlled before the airway sequence in trauma logic. Otherwise, an obstructed airway outranks everything; a breathing problem outranks a circulation problem; circulation outranks pain, fever, and every "important but not lethal" finding.
Physiological needs before safety, safety before love/belonging, belonging before esteem and self-actualization. On the exam, Maslow mostly answers fundamental and psych questions: food, fluids, oxygen, and sleep outrank teaching, coping, and self-image — until safety (suicidal intent, fall risk) jumps the queue.
| Can receive | Never receives | |
|---|---|---|
| UAP (aide/tech) | ADLs, ambulation, intake/output, vital signs on stable clients, hygiene, feeding clients without swallowing risk | Assessment, teaching, evaluation, medications, anything requiring clinical judgment |
| LPN/LVN | Medications (with standard exceptions), dressings, monitoring, data collection on stable clients, care of clients with predictable outcomes | Initial assessment, care planning, admission assessment, IV push medications and blood-product initiation in the standard textbook scope, teaching plan creation |
| RN only | Assessment, nursing diagnosis, planning, teaching, evaluation — the nursing process itself | — |
Mantra that answers most items: the RN can delegate tasks, never thinking. If the option requires assessing, judging, teaching, or evaluating — it stays with the RN.
Q1. Four clients need you. Who do you see first?
A. A client with COPD, SpO₂ 90% on 2 L, eating breakfast
B. A client 6 hours post-op reporting new shortness of breath and chest pain
C. A client with chronic back pain rating it 8/10, due for medication
D. A diabetic client whose fasting glucose is 182 mg/dL
Answer: B — new, acute, unexpected, and a breathing/circulation threat. A is at an expected baseline, C is severe but chronic and stable, D is a routine abnormal value. Acute + unexpected + ABC wins.
Q2. Which task can the RN delegate to an experienced UAP?
A. Assessing a new admission's lung sounds
B. Teaching a newly diagnosed diabetic to draw up insulin
C. Ambulating a stable post-op client for the third time today
D. Evaluating whether a client's pain plan is working
Answer: C — a routine task on a stable client. A is assessment, B is teaching, D is evaluation: three legs of the nursing process, all RN-only.
Q3. Which assignment is appropriate for the LPN?
A. The client admitted an hour ago who needs an initial assessment
B. The unstable client with titrating IV drips
C. The stable client, day 3 post-op, needing scheduled oral medications and a dressing change
D. The client who needs discharge teaching designed today
Answer: C — stable, predictable outcomes, within LPN scope. A needs the RN's initial assessment, B is unstable, D is teaching-plan creation.
Module 7 of the Core Bundle contains 35 questions like these — four-patient sprints, delegation grids, consent and legal scenarios — plus a full case study of a deteriorating assignment, and Drill Set 7 adds 30 more.
Next Gen NCLEX questions are where exams are won and lost. Our free field guide walks through every NGN item type — case study, bow-tie, trend, cloze, matrix — with fully worked examples and the scoring explained in plain English.