Patient Care and Management
What the exam tests
Care and management items test the planning cycle: assess, diagnose the problem, plan, implement, and evaluate. Know how to build an individualized care plan with measurable goals, apply evidence-based practice, coordinate care across settings, and educate patients in a way they can act on. Medication administration questions expect the classic rights - right patient, drug, dose, route, time, documentation, and reason - plus the patient's right to refuse. Delegation is heavily tested: tasks can be delegated to trained assistive personnel, but assessment, teaching, evaluation, and clinical judgment cannot.
Traps
Watch for plans that are never evaluated or that continue despite no improvement. Delegation traps pair a task with a judgment component, such as asking assistive personnel to "decide if the patient is stable." Medication items may omit one right or describe a workaround (borrowing a dose, skipping a scan). Shared decision-making items penalize both paternalism and abandoning the patient to choose alone. Also beware of answering with a task when the question asks for the priority - often monitoring or escalation comes first.
Worked example
A nurse delegates vital signs and intake/output to assistive personnel. When the aide reports a rising pulse and falling blood pressure, the nurse - not the aide - interprets the data, assesses the patient, and escalates. The task was delegable; the judgment was not.
Rule of thumb
If an action requires nursing judgment, assessment, teaching, or evaluation, it stays with the licensed professional. Write goals that are specific, measurable, and time-bound, then evaluate them.