Priority Stems, Intervention Stems, and Select-All Stems
A four-rung vertical ladder down the left gutter with three parallel tracks running right, tiles filled where a rung behaves differently by family and left empty where it behaves the same.
Classify the family first. The same option can be right in one family and wrong in another, and running the wrong ladder is a faster way to lose an item than not knowing the content.
| PRIORITY | INTERVENTION | SELECT ALL | |
|---|---|---|---|
| Rung 1 · what is the stem asking for | Who or what comes first. Every option may be correct; only one is first. | What you do. The options are actions, not facts. | Which of these statements is true of this client, one at a time. |
| Rung 2 · the first move | Sort options into unstable and stable before you rank anything. | Ask whether the assessment that would justify this action has already been stated in the stem. | Cover the other options. Physically. A finger on the screen edge works. |
| Rung 3 · the elimination test | Comparative, never absolute. The question is not "is this bad" but "is this worse than that." | Does the action follow from what the stem told you, and does it belong to the nurse right now. | Score each option as its own true-or-false question against the stem, in isolation, never against the other options. |
| Rung 4 · the trap that lives here | The loudest finding beating the quietest dangerous one. Pain and distress are loud; a changed respiratory pattern is quiet. | Documenting or notifying in place of acting, or acting before assessing. Critical. | Aiming for a number. Deciding that three feels right, or that all six cannot possibly be correct. |
| Time budget | One standard item allowance. Sorting is fast once you stop ranking prematurely. | One standard item allowance. The assessment-versus-action check is a two-second question. | Standard plus about half again, because you are genuinely answering as many questions as there are options. |
The select-all method, in order
- Read the last sentence and name the population the options must be true for.
- Cover every option except the one you are reading.
- Ask one question only: is this true, for this client, at this time.
- Mark yes or no. Do not revisit, do not compare, do not count.
- Uncover, submit. The number is whatever it turned out to be.
Verify: How select-all and matrix responses are credited, including whether partial credit applies, is published by NCSBN and can change. Confirm it in the current candidate bulletin.
Margin noteselect-all is five questions wearing a trench coat.
☐ I can classify a priority stem in ten seconds. ☐ Intervention stem. ☐ Select-all stem.
TakeawayClassify the family first, then run the ladder, because the ladder is what stops you from answering with your reflex. → BOOK 03 · P6 · → BOOK 01 · P15