NCLEX-RN · Client-needs page 1 · 3 min read

The largest NCLEX-RN client-needs category (15 to 21% of items): prioritizing by acuity, delegation and supervision, handoff, orders, consent, advance directives, confidentiality, ethics and scope of practice. What it covers, how it is tested, a worked example and the usual traps.

What this category covers

Management of Care is about running safe care for a group of clients rather than doing one task well. In the 2026 test plan it is the biggest single category, at 15 to 21% of scored items, so on a short exam expect roughly one item in six to come from here.

The test plan's activity list covers, in short:

• Prioritizing care by acuity and organizing your workload.
• Delegating to and supervising LPN/VNs, assistive personnel and other RNs.
• Handoff: giving and receiving report; admission, transfer and discharge.
• Orders: receiving, verifying and carrying out provider orders; obtaining referrals.
• Rights and consent: advocacy, informed consent (verifying the client was taught and consented), advance directives, confidentiality and privacy, including on social media.
• Legal and ethical practice: scope of practice, the nurses' code of ethics, mandatory reporting (abuse, neglect, certain communicable diseases), recognizing ethical dilemmas.
• The team: collaborating with other disciplines, managing conflict, quality improvement, cost-effective care.

How it is usually tested

Most Management of Care items are about choice under pressure: which client first, which task to whom, which order to question. Expect single-answer multiple choice ("which client should the nurse see first?"), select-all-that-apply for delegation ("which tasks can be assigned to the assistive personnel?"), matrix grids that sort tasks between RN, LPN/VN and assistive personnel, and ordered-response items for the sequence of a handoff or a discharge.

Worked example (our own)

The RN is working with an LPN and an assistive personnel (AP) on a medical unit. Which tasks can the RN give to the AP?

1. Taking vital signs on a client who had a stable hip replacement two days ago.
2. Teaching a newly diagnosed client how to use an insulin pen.
3. Helping a client with a stable stroke to eat lunch, using the swallowing plan the speech therapist wrote.
4. Assessing a client who has just returned from a cardiac catheterization.
5. Measuring and recording urine output for a client on intake and output.

Answer: 1, 3 and 5. These are routine, standard tasks for a stable client with a predictable outcome and a clear plan. Teaching (2) and assessment of a client whose condition may change (4) need the nursing judgment of an RN. A useful test: if the task needs assessment, teaching, evaluation or judgment, or the client is unstable, it stays with the RN. The RN still owns the outcome of anything delegated, so the instruction to the AP should say what to report (for example, "tell me if the systolic pressure is below 100").

Common pitfalls

• Choosing the most interesting client, not the most unstable. Airway, breathing and circulation come first; then acute over chronic, unexpected over expected, and actual problems over risks.
• Delegating the evaluation along with the task. The AP can take a blood pressure; the RN decides what it means.
• Treating consent as the nurse's job to explain. The provider explains the procedure and obtains consent; the nurse verifies that it happened, that the client understood, and witnesses the signature. If the client has questions, the nurse stops and calls the provider.
• Following an order that is unsafe. Verify and clarify; do not carry out an order you believe is wrong, and do not simply ignore it either.
• Sharing information to be kind. Confidentiality holds with family, coworkers not involved in care, and online.

Category names and percentage ranges: NCSBN, 2026 NCLEX-RN Test Plan (effective April 1, 2026 to March 31, 2029). Portions copyrighted by the National Council of State Boards of Nursing, Inc. All rights reserved. Explanations and examples are our own.