Safe and Effective Care Environment

In order to achieve the best possible outcomes, nurses must provide and direct a safe care environment to protect both clinicians and patients.  This category will be further broken into two subcategories:

  1. Management of Care
  2. Safety & Infection Control

The topics covered in these sections include a wide range of professional, legal, and ethical nursing responsibilities, as well as information regarding transmission precautions and safety devices.

Management of Care

Management of care means giving and managing nursing care that improves healthcare delivery to clients and other healthcare personnel.  This subcategory accounts for 20% of the questions on the NCLEX-RN exam. The nursing knowledge required for this exam includes:

Advance Directives

This section will dive into advance directives like the living will, health care proxy, Power of Attorney for Health Care.  The nursing actions required with advance directives include assessing client knowledge, care planning, education, self-care determination, and life planning.


One of the many roles of a Registered Nurse involves being a patient advocate.  This section will discuss the importance of patient advocacy as a nurse, including assisting clients with identifying treatment options and respecting their decisions, empowering staff members to be advocates, acting as a patient advocate, and using advocacy resources appropriately.

Assignment, Delegation, and Supervision

Registered nurses must organize their assignment to manage time effectively and identify tasks that are appropriate for delegation based on the licensure, education, and skills of the personnel performing the delegated tasks.  When they assign care to others, they must supervise the personnel, clearly communicated the tasks to be completed, and evaluate the tasks to ensure accurate completion.  This section will cover detailed information from above and also review the five rights of delegation to be considered prior to delegating the tasks.

Case Management

This section will discuss the benefits of Registered Nurses as case managers and they ensure clients are provided with the appropriate services of a multidisciplinary healthcare team like physical therapy services, home health nursing, and respiratory care.  Registered Nurse case managers connect, refer, and link clients to the medical and community services they need based on the level of care assessed.  Case managers coordinate care for complex clients and locate high quality, effective, timely, complete, and cost-effective.  They are able to screen patients for risk factors, increasing needs, and higher levels of care to make sure that all needs are being met.  Case managers have a wealth of community resources like medical equipment and interdisciplinary services that they can draw on to find the best possible care for each client.

Client Rights

In the section about client rights, Registered Nurses will demonstrate their knowledge and skills surrounding the clients right to refuse treatment, discuss medical options, provide education about client rights, evaluate client and staff understanding of client rights, and advocate for client rights and needs. The Registered Nurse should be familiar with the American Hospital Association’s Patient Care Partnership. Under this, patients have the right to privacy, confidentiality, respect and dignity, patient autonomy, competent and compassionate care, and protect both social and religious freedom.  Registered Nurses should also ensure that clients are able to select their own health care provider, access to emergency services, freedom from abuse or neglect, manage and control their finances and personal property, understand about all medical conditions and treatments that pertain to them without any withholding of information, be billed accurately for healthcare services, and express their complaints and have them be appropriately addressed.  This will be further addressed in detail in the client rights section.

Collaboration with the Interdisciplinary Team

This section will cover collaboration with the interdisciplinary team.  The Registered Nurse must identify the need for interdisciplinary conferences, review the care plan to ensure continuity of care across disciplines, collaborate with healthcare team members, and serve as a resource person to other staff.  The Registered Nurse identifies significant information to report to other disciplines

Concepts of Management

This section will cover Registered Nurses and relevant concepts of management.Registered Nurses must distinguish between health care team member roles, create plans to deal with patient issues, manage and coordinate care, manage conflict, and assess management outcomes.  Registered Nurses excel in management by establishing goals and objectives by creating plans, organizing, focusing actions s towards those established goals.

Confidentiality and Information Security

This section will discuss confidentiality and information security by urging Registered Nurses to maintain client confidentiality and privacy by adhering to confidentiality requirements.  RNs must intervene accordingly when confidentiality or security is at risk of being breached and report to the appropriate authorities when it has been breached.  


This section will discuss consultation as covered by the NCLEX-RN exam.  A Registered Nurse must determine when it is appropriate to recommend a consultation to an interdisciplinary field or consult with a supervisor or colleague.

Continuity of Care

This section will discuss promotion of continuity of care as a Registered Nurse.Continuity of care ensures the standardization of communication for hand-off report and that communication is relatable on all medical records and forms.  Continuity of care also means that medical professionals use standard terminology when recording care, following up on unresolved issues regarding client care and making sure that nothing is omitted on admission, transfers, and discharge.

Establishing Priorities

This section reviews the importance of Registered Nurses establishing priorities for the delivery of patient.  RNs must apply their knowledge of pathophysiology for nursing interventions, evaluate the resulting plan of care, and revise the nursing care plan for multiple clients.

Ethical Practice

This section covers the importance of Registered Nurses using ethical practice in their nursing career.  RNs must recognize ethical dilemmas, take the appropriate next steps, inform clients and co-workers about ethical issues, practice within the code of ethics for RNs, and evaluate the outcome of ethical practice.

Information Technology

This section will review how Registered Nurses obtain health care provider orders, retrieve patient data through online databases and journals, and use information technology to enhance patient care delivery.  RNs are required to submit computer documentation accurately, completely, and in a timely manner.

Informed Consent

This section covers Registered Nurses responsibility to provide informed consent for the client.  RNs must identify the appropriate person to provide informed consent for the client (parent, legal guardian, or client), provide written materials in the correct language, understand components of informed consent, participate in obtaining informed consent when applicable, and verify the client comprehends the risks and benefits and consents to care and procedures.

Legal Rights and Responsibilities

Registered Nurses must be cognizant of the legal rights and responsibilities surrounding nursing care.  This section discusses what legal issues RNs should be able to identify that directly affect the client, manage the client’s valuables according to facility guidelines, acknowledge personal limitations and obtain support, examine facility policy and state mandates, educate client and staff on legal issues, report legally mandated conditions (abuse, neglect, communicable diseases), and provide nursing care within their legal scope of practice as a Registered Nurse.  RNs also must report unsafe practices to health care personnel and intervene as appropriate.

Organ Donation

This section will discuss the important issues surrounding organ donation that may be covered in the NCLEX-RN.  The RN should be aware of the legal implications involved in organ donation and transplant, assess the client for risk factors, provide education to the client and family members, and evaluate appropriate candidates for organ donation.

Performance Improvement and Risk Management

This section will define performance improvement and risk management as it pertains to Registered Nurses.  Nurses must understand quality assurance (QA) and performance improvement activities, participate in QA and quality improvement (QI) processes, report client care issues to the appropriate personnel (risk manager or nurse manager), use research and other evidence-based references for performance improvement actions, and evaluate the impact of these measures on client care.


This section will discuss client referrals as it pertains to Registered Nurses.  RNs will assess the need to refer patients for assistance with actual or potential problems (physical therapy and other services), recognize the need for referrals, obtain physician or practitioner orders, identify community resources for the client (respite care, social services, shelters), and identify which documents to include when completing the referral (health record, referral form).

Safety and Infection Control

Safety and infection control enables nurses to protect patients, nurses, and other healthcare personnel from environmental and health hazards.  This subcategory accounts for 12% of the questions on the NCLEX-RN exam.  The nursing actions required for this exam are as follows:

Accident and Injury Prevention

This section will discuss how the Registered Nurse must engage in accident and injury prevention.Registered Nurses must understand safety procedures, provide a call light or other method for them to signal staff members, and make appropriate room assignments based on physical and cognitive impairments.  RNs must also identify factors that put a client at risk for falls and other injuries, implement seizure precautions when appropriate,facilitate the correct use of car seats for children and babies, and review modifications to activities to promote musculoskeletal health and prevent injury.

Emergency Response Plan

In this section for NCLEX-RN preparation, the Registered Nurse will be expected to understand the intricacies of the emergency response plan.  The Registered Nurse will determine which clients to propose for discharge in a disaster situation, identify nursing roles during an emergency, use critical thinking and triage skills for planning purposes, implement emergency response plans, and participate in disaster planning activities.

Ergonomic Principles

In this section, the Registered Nurse must be aware of ergonomic principles to prepare for the NCLEX-RN exam.  The RN will assess the client’s mobility and use of assistive devices to balance, transfer, and ambulate and then provide education about proper body mechanics and mobility devices.  It is imperative that RNs use ergonomic principles when they are providing nursing care.

Error Prevention

This section will prepare you for the section of the NCLEX-RN about error prevention.  It is critical that the RN assess all clients for allergies to medications, food, latex, and the environment.  The RN must ensure proper identification of client in each instance of providing care, verify physician orders for treatments and medications, and ensure that physician orders are appropriate and accurate.  

Handling Hazardous and Infectious Materials

This section will prepare you for NCLEX-RN exam materialcovering handling hazardous and infectious materials.  This includes identifying biohazardous, flammable, radiation, and infectious materials.   RNs must follow facility and state-mandated procedures for handling biohazardous and internal radiation therapy materials, demonstrate safe handling techniques and dispose of the hazardous or infectious material appropriately.  

Home Safety

This section will prepare the RN to assess home safety during home visits and while performing discharge education.  It is important for RNs to assess the client’s need for home modifications, educate regarding home safety issues, promote the use of protective equipment (i.e. syringe box), and evaluate the environment for hazards.  

Reporting of Incident, Event, Irregular Occurrence, or Variance

This section will discuss the important issue of incident reporting as covered by the NCLEX-RN exam.  The RN must identify the circumstance where incident reporting is appropriate (including event, irregular occurrence, or variance reporting), recognize and document any errors on the facility based reporting document (i.e. incident report), and evaluate any negative response to the error (or event/occurrence)

Safe Use of Equipment

This section will detail the safe use of equipment portion of the NCLEX-RN exam.  The Registered Nurse must inspect all medical equipment for safety hazards, facilitate safe use of medical equipment, teach clients how to safely use medical equipment, and remove any malfunctioning equipment from the client care area and report the problem to the proper department.

Security plan

This section will discuss the importance of a security plan to Registered Nurses.  RNs must use clinical decision-making and critical thinking for planning, apply procedures for evacuation, perform principles of triage, and participate in facility security plan (i.e. missing child, bomb threats).

Surgical Asepsis, Standard, and Transmission-based Precautions 

This section will cover surgical asepsis, standard precautions, and transmission-based precautions that may be covered on the NCLEX-RN exam.  The RN must assess the health care area for infection sources, understand communicable disease and the modes of transmission (airborne, droplet, or contact), apply principles of infection control (surgical asepsis, hand hygiene, isolation, sterile technique, universal precautions), and use appropriate techniques to set up a sterile field.  RNs must know how to maintain asepsis, follow correct policy and procedures for communicable disease including reporting a client with a communicable disease, educate staff regarding infection control processes, use precautions for immunocompromised patients, evaluate proper use of aseptic technique and infection control precautions.

Use of Restraints and Safety Devices

This section will discuss the use of restraints and safety devices as covered in the NCLEX-RN exam.Using physical restraints and safety devices requires careful knowledge of agency policies and following those requirements.  The RN must assess the suitability of the type of restraint or safety device being used, use the least restrictive restraints with timed monitoring, and evaluate patient response to the restraints and safety devices.