Think In Stacks Method

One path. Every question. Stop when you find your answer.

1 Identify Question Type
Assessment (gather, review) Priority (first, immediate) Implementation (do, teach) Evaluation (outcome) Ordered (sequence, order)
2 Assessment Questions
✓ CHOOSE THIS
Baseline data: patterns, trends, usual habits
✗ SKIP THESE
Why questions, causes, teaching
"B-4 you treat, know the baseline"
3 Priority Questions - Stack of Four
1. Airway → Breathing → Circulation → Disability
2. Safety/Risk (PHYSICAL harm only)
3. Maslow Physiological (pain, nutrition, fluids, sleep, elimination)
4. Nursing Process (assess before act)
↓ Psychosocial needs (anxiety, coping, emotional) come AFTER Stack #4 ↓

Single Answer: Stop at first match
SATA: Check ALL options, select all matches

4 Implementation Questions
Stable = Delegate ↔ Unstable = RN
Least → Most Invasive (position → meds → procedures)
Independent → Dependent (nursing actions → provider orders)
5 Evaluation Questions

Look for proof the goal was met:

  • Labs within normal range
  • Symptoms resolved
  • Client verbalizes understanding in own words
  • Demonstrates correct technique
6 Ordered Response Questions
Step 1: Identify ALL correct actions (like SATA)
Step 2: Arrange using Stack of Four priority
Step 3: ABCD → Safety → Maslow → Process
⚠ Different from SATA - you must sequence the actions!
🎯 TIE-BREAKER RULES (Same Stack Level)

RULE #1: If assessment option exists about the tied items → ASSESSMENT WINS

Example: "Assess voiding patterns" beats "Address nutrition" when both are Stack #3

RULE #2: No assessment option? Use urgency levels:

Stack #3 Physiological Urgency (highest to lowest):
Glucose/Diabetic needs (hours)
Elimination problems (hours-days)*
Pain (hours-days)
Fluids/Hydration (days)
Nutrition (days-weeks)
Sleep (days-weeks)
Temperature (varies)
Activity/Exercise (weeks)

*Elimination with complications (retention, impaction) jumps to Stack #2

NCLEX Quick Reference v2

1. Identify Question Type

Assess: gather Priority: first Do: action Eval: outcome Order: sequence

Stack of Four

1. A-B-C-D
2. Safety (PHYSICAL only)
3. Maslow: nutrition, sleep, pain
4. Assess→Act
"Always Be Caring Daily"

Question Formats

Single: Stop at 1st Stack match

SATA: Check all → Pick all matches

Order: Pick all → Sort by Stack

Quick Rules

• Assess: Baseline > Causes

• Implement: Least → Most invasive

• Delegate: Stable=Yes, Unstable=No

• Evaluate: Own words = Got it

🎯 Tie-Breakers

Same Stack Level?

1. Assessment about tied items → WINS

2. No assessment? → Use urgency:

  • Hours: Glucose, Urine
  • Days: Pain, Fluids
  • Weeks: Food, Sleep, Activity

When the Framework Bends: NCLEX Exceptions

The 5% of questions that require special handling

⏱ Exception #1: Time Sequence

Looks Like: "After...", "Following...", "Has already...", "Next..."

Trap: Highest priority already completed

Example: "After establishing airway..."
✗ Check airway again
✓ Move to breathing

Handle:

  1. ID completed actions
  2. Start Stack where they left off
  3. Move to next in sequence
⊘ Exception #2: Exclusion

Looks Like: "EXCEPT...", "AVOID...", "NOT appropriate..."

Trap: Brain picks BEST, question wants WORST

Example: "All appropriate EXCEPT:"
✗ Pick best action
✓ Find harmful action

Handle:

  1. Circle EXCEPT in red
  2. Reverse thinking
  3. Find dangerous option
  4. Often highest Stack (too aggressive)
↻ Exception #3: Chronic vs New

Looks Like: "Usual...", "Chronic...", "Sudden...", "New onset..."

Trap: Stack prioritizes chronic high over new low

Example: Chronic pain 8/10 + New confusion
✗ Treat pain (Stack #3)
✓ Assess confusion (new problem)

Handle:

  1. Flag chronic/usual
  2. Highlight new/sudden
  3. New beats chronic
  4. Acute jumps up a Stack
◎ Exception #4: Context-Specific

Looks Like: Psych unit, Cultural, Legal/ethical, Pediatric

Trap: Context changes priority meaning

Psych: Suicidal + needs insulin
✗ Glucose first
✓ Suicide = Safety (Stack #2)
Legal: Refusing treatment
✗ Force treatment
✓ Respect autonomy
⛊ SAFETY NET PROTOCOL

1. Re-Read for Qualifiers

After Except Not Independent First Most/Least

2. Override Rules

→ New > Old (even if old higher)

→ Unexpected > Expected

→ Reversible > Irreversible

→ Legal/Ethics > Clinical (sometimes)

Rapid Filters: The Test-Taker's Safety Net

Your 6-second defense against wrong answers

🔍 Filter #1: Baseline vs. Change

Purpose: Don't assume problems exist

How to use: Look for "increased," "worsening," "new" - if no baseline given, need assessment first

Example: "Diabetic patient has blood sugar of 150"
Is this HIGH for this patient? Don't assume!

🚫 Filter #2: Absolute Words

Danger words: Always, Never, All, None, Only, Every, Must

EXCEPTIONS: Safety protocols, legal requirements, standard precautions

See absolute word → Mark suspicious → Check if safety/legal → If not, probably wrong

👯 Filter #3: Duplicate Options

Rule: If two options say the same thing → BOTH are wrong

Example:
A. "Notify physician"
B. "Call the doctor"
→ Both out!

☂️ Filter #4: Umbrella Option

What wins: The most comprehensive answer that covers multiple aspects

✗ "Check pulse"
✓ "Assess circulation, sensation, and movement"

💝 Filter #5: Client-Centered Language

Winners: "Encourage client to...", "Assist patient with...", "Support decision to..."

Losers: "Nurse will perform...", "Do this for patient..."

EXCEPTION: Emergency situations override this

🎯 Filter #6: First Instinct Rule

Statistics:
First instinct = 75% correct
Changed answers = 55% correct

About to change? STOP and ask why!

Practice Mode

Test your understanding with interactive scenarios

Sample Question

A patient with heart failure reports feeling more short of breath than usual. The nurse should:

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