The 8 rules that answer a third of the exam. If you are short on time, learn these first.
- ASSESS FIRST. Fall, med error, refusal, new symptom — always assess the client before you notify, document, or fix anything.
- ABC, then Maslow. Airway → Breathing → Circulation. Then physiological → safety → psychological.
- Unstable before stable, acute before chronic, actual before risk-for.
- Least invasive first. Reposition before you suction; bladder scan before you catheterize.
- Never delegate assessment, teaching, evaluation, or an unstable client. UAPs get tasks, not judgment.
- Absolutes are almost always wrong. always, never, all, only, every.
- Self-report is the gold standard for pain. Pain is whatever the client says it is.
- Read the stem twice — half of ATI's difficulty is a negatively worded question ("needs further teaching") that you answered positively.
🔢 Numbers ATI expects you to know cold
🧴 Infection control — guaranteed points
Stages of infection: Incubation (exposed, no symptoms) → PRODROMAL (vague symptoms, MOST CONTAGIOUS) → Illness (specific symptoms) → Convalescence (recovery).
Alcohol hand rub does NOT work on C. difficile or norovirus. Soap and water — the friction physically removes the spores. Also wash (don't rub) whenever hands are visibly soiled.
Order matters. Donning: gown → mask → goggles → gloves. Doffing: gloves → goggles → gown → mask (dirtiest first, and the mask comes off last, outside the room).
🩹 Pressure injury staging
Prevention: reposition q2h · pillow under the CALVES to float the heels (never under the knees) · HOB ≤30° · keep skin clean and dry · barrier cream · lift sheet, don't drag · NO donut cushions · NEVER massage a bony prominence.
🩸 Wound drainage & healing
Healing intentions: Primary = closed surgically, minimal scar · Secondary = left open, granulates from the bottom up, more scarring · Tertiary = left open 5–10 days to treat infection, then closed (delayed primary closure).
Evisceration: cover with sterile saline-soaked gauze (never dry, never reinsert), low-Fowler's with knees bent, NPO, call the surgeon.
💉 Medication safety
Rights: right client (two identifiers — never the room number), drug, dose, route, time, documentation, reason, response, education, refusal. Three checks: pulling it, preparing it, and at the bedside.
Do-not-use abbreviations: QD, QOD, U, IU, MS/MSO₄, trailing zeros (2.0 mg), naked decimals (.5 mg). Write 0.5 mg and 2 mg.
Insulin: clear before cloudy · only regular insulin goes IV · never mix glargine · rotate sites · never reuse a needle.
Never crush enteric-coated or extended-release. For dysphagia, look for a liquid form first.
💨 Oxygen delivery
Hypoxia: EARLY = restlessness, anxiety, tachycardia, tachypnea. LATE = cyanosis, bradycardia, confusion. Restlessness is the first sign — treat it as hypoxia until proven otherwise.
Suctioning: sterile technique · hyperoxygenate first · ≤10–15 seconds · suction only on the way OUT · rest between passes.
Sterile field: 1-inch border is contaminated · keep it above your waist · in your sight at all times · wet = contaminated.
🗣️ Therapeutic communication
SBAR — Situation (what's happening now), Background (relevant history), Assessment (what you think it is), Recommendation (what you want).
Teach-back is how you evaluate learning — have them explain it back or demonstrate it. Never just ask "do you understand?"
Interpreters must be qualified and professional — never a family member, never a child. Look at and speak to the client.
🛡️ Levels of prevention
Classify by where the client is in the disease: no disease → primary · disease present but silent → secondary · disease established → tertiary.
⚰️ End of life
Palliative = any stage, any age, alongside curative treatment. Hospice = prognosis around 6 months or less, curative treatment stopped.
Hearing is believed to be the last sense to go — keep talking to the client.
Post-mortem: dentures in before rigor mortis · elevate the head slightly · close the eyelids gently · do not remove tubes if there's an autopsy or coroner's case.
🧮 Conversions you must have memorized
Formula: Desired ÷ Have × Quantity. IV pump: mL ÷ hr. Drip rate: (volume × drop factor) ÷ minutes.
Logic check: kilograms is always the smaller number than pounds. If you want more than you have on hand, your answer must be more than one unit.
Round only at the end. Leading zero yes (0.5), trailing zero never (2.0).
Delegation cheat: a UAP can do standard, predictable tasks on a stable client — bathing, feeding, positioning, ambulating, vital signs, I&O, weights.
They can never assess, teach, evaluate, or take an unstable client. If three options are assessments and one is a task, the task is your answer.