ATI MED – SURG PROCTORED NOTES BANK LATEST 2026
NEW NGN WITH REVISED AND FULL 100%
1. Pain Management – Core Principles (Questions 1–20+)
• Types of pain
o Somatic: well-localized, aching (from skin, muscles, joints)
o Visceral: poorly localized, cramping/pressure (organs)
o Neuropathic: burning, shooting, electric (nerve damage)
o Breakthrough: sudden severe flare in chronic pain patient
(usually needs immediate-release opioid)
• WHO Analgesic Ladder reminder
o Step 1: Non-opioid ± adjuvant
o Step 2: Weak opioid + non-opioid ± adjuvant
o Step 3: Strong opioid + non-opioid ± adjuvant
• Most important outcome measures
o Functional ability > pain score alone
o “Can you do what you want/need to do?” is almost always
the best evaluation question
• Opioid side effects – highest priority
o Respiratory depression → sedation scale + RR first
o Constipation → always anticipate & prevent
o Nausea → usually resolves; switch opioid if persistent
• Epidural morphine red flags
, o Urinary retention → ask “Do you feel the need to void?” first
(before catheter)
o Late respiratory depression (up to 24 h)
• Delegation to UAP
o Vital signs (including RR q2h on fentanyl patch)
o NOT sedation/pain assessment, PCA bolus teaching, or
opioid titration
• Breakthrough dose rule of thumb
o Immediate-release opioid ≈ 10–20% of 24-hour long-acting
dose every 1–2 h PRN
2. Inflammation & Wound Healing – Pressure Ulcers & Surgical
Wounds
• Pressure ulcer staging quick reference
o Stage 1: Non-blanchable erythema
o Stage 2: Partial-thickness skin loss (shallow open ulcer)
o Stage 3: Full-thickness, subcutaneous fat visible (no
bone/tendon)
o Stage 4: Bone, tendon, muscle exposed
o Unstageable: Full-thickness, base covered by slough/eschar
o Suspected deep tissue injury: Purple/maroon localized area
• Wound appearance color code
o Red = granulating (good, proliferative phase)
o Yellow = sloughy (needs debridement)
NEW NGN WITH REVISED AND FULL 100%
1. Pain Management – Core Principles (Questions 1–20+)
• Types of pain
o Somatic: well-localized, aching (from skin, muscles, joints)
o Visceral: poorly localized, cramping/pressure (organs)
o Neuropathic: burning, shooting, electric (nerve damage)
o Breakthrough: sudden severe flare in chronic pain patient
(usually needs immediate-release opioid)
• WHO Analgesic Ladder reminder
o Step 1: Non-opioid ± adjuvant
o Step 2: Weak opioid + non-opioid ± adjuvant
o Step 3: Strong opioid + non-opioid ± adjuvant
• Most important outcome measures
o Functional ability > pain score alone
o “Can you do what you want/need to do?” is almost always
the best evaluation question
• Opioid side effects – highest priority
o Respiratory depression → sedation scale + RR first
o Constipation → always anticipate & prevent
o Nausea → usually resolves; switch opioid if persistent
• Epidural morphine red flags
, o Urinary retention → ask “Do you feel the need to void?” first
(before catheter)
o Late respiratory depression (up to 24 h)
• Delegation to UAP
o Vital signs (including RR q2h on fentanyl patch)
o NOT sedation/pain assessment, PCA bolus teaching, or
opioid titration
• Breakthrough dose rule of thumb
o Immediate-release opioid ≈ 10–20% of 24-hour long-acting
dose every 1–2 h PRN
2. Inflammation & Wound Healing – Pressure Ulcers & Surgical
Wounds
• Pressure ulcer staging quick reference
o Stage 1: Non-blanchable erythema
o Stage 2: Partial-thickness skin loss (shallow open ulcer)
o Stage 3: Full-thickness, subcutaneous fat visible (no
bone/tendon)
o Stage 4: Bone, tendon, muscle exposed
o Unstageable: Full-thickness, base covered by slough/eschar
o Suspected deep tissue injury: Purple/maroon localized area
• Wound appearance color code
o Red = granulating (good, proliferative phase)
o Yellow = sloughy (needs debridement)
