Practice Study Guides Blog Flashcards Español

All Practice Exams

198+ Free CSFA Practice Questions

Pass your NBSTSA Certified Surgical First Assistant exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~68% Pass Rate

198+ Questions

100% Free

1 / 198

Question 1

Score: 0/0

Which position places the patient at highest risk for brachial plexus injury during prolonged surgery?

A

Supine with arms tucked at sides

B

Trendelenburg with arms extended on armboards

C

Lateral decubitus with dependent arm in axillary roll

D

Prone with arms abducted to 90 degrees on armboards

to track

2026 Statistics

Key Facts: CSFA Exam

175

Total Exam Questions

NBSTSA 2025 Candidate Handbook

150 scored

Scored Items (25 unscored pretest)

NBSTSA 2025 Candidate Handbook

98/150

Passing Score (65.3%)

NBSTSA 2025 Candidate Handbook

4 hours

Exam Duration

NBSTSA 2025 Candidate Handbook

$300-400

Exam Fee

NBSTSA 2025 Candidate Handbook

55%

Perioperative Care Content

NBSTSA content outline

NBSTSA's CSFA exam consists of 175 total questions (150 scored + 25 unscored pretest items) delivered in 4 hours at Pearson VUE test centers. Passing requires 98 correct of 150 scored items (65.3%). Perioperative Care dominates at 55% of content, split between Intraoperative Procedures (45.3%), Preoperative (6%), and Postoperative (3.7%). Basic Science accounts for 31% (Anatomy/Physiology 20.7%, Microbiology 3.3%, Pharmacology/Anesthesia 3.3%), while Ancillary Duties covers 14% (Admin/Personnel 4%, Equipment 10%).

Sample CSFA Practice Questions

Try these sample questions to test your CSFA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 198+ question experience with AI tutoring.

1Which position places the patient at highest risk for brachial plexus injury during prolonged surgery?

A.Supine with arms tucked at sides

B.Trendelenburg with arms extended on armboards

C.Lateral decubitus with dependent arm in axillary roll

D.Prone with arms abducted to 90 degrees on armboards

Explanation: The prone position with arms abducted to 90 degrees on armboards places the brachial plexus under significant stretch, especially during prolonged procedures. This position, combined with improper padding or excessive rotation, can cause neuropraxia or more severe nerve injury. Arms should ideally be positioned at less than 90 degrees abduction to minimize stretch on the brachial plexus.

2What is the proper sequence for surgical skin preparation when prepping the abdomen?

A.Center to periphery in circular motion

B.Periphery to center in circular motion

C.Top to bottom in linear strokes

D.Side to side in horizontal strokes

Explanation: Surgical skin preparation should proceed from the cleanest area (the proposed incision site) to the periphery using a circular motion. This technique prevents dragging contaminants from the less clean peripheral areas toward the surgical site. The prep area should extend at least 2 inches beyond the expected draped field.

3When performing a surgical count, at which of the following times MUST counts be performed?

A.Only at the beginning and end of the procedure

B.Before closure of the first cavity, at skin closure, and with any relief scrub

C.Only when the surgeon requests a count

D.At the beginning of the procedure and at end of the day

Explanation: Surgical counts must be performed at specific critical times: before the procedure begins (baseline), before closure of any cavity (abdomen, chest, pelvis), at skin closure or end of procedure, and whenever there is a relief scrub (change of personnel). This protocol ensures accountability and prevents retained surgical items.

4Which type of suture needle is most appropriate for closing the fascia during an abdominal incision?

A.Taper-cut needle

B.Taper point needle

C.Reverse cutting needle

D.Spatula needle

Explanation: A taper point needle is most appropriate for fascial closure because fascia is tough, fibrous tissue that requires a needle that can penetrate without cutting. The taper point needle has a round body that gradually tapers to a point, allowing it to separate tissue fibers rather than cutting them, which provides better wound healing strength in dense tissues like fascia.

5What is the primary mechanism of action of bipolar electrocautery?

A.Current flows from active electrode through patient to ground plate

B.Current flows only between the two tips of the instrument

C.Current is delivered as high-voltage sparks to tissue

D.Current is converted to ultrasonic energy for cutting

Explanation: Bipolar electrocautery works by passing electrical current between the two tips of the instrument only, which grasp the tissue. This localized current flow means no dispersive electrode (grounding pad) is needed, and there is minimal risk of current diversion or capacitive coupling burns. It is safer for use near critical structures and in patients with pacemakers.

6During a thyroidectomy, the surgeon asks for a "spinal needle" to identify the recurrent laryngeal nerve. What is the purpose of this technique?

A.To inject local anesthetic for nerve block

B.To stimulate the nerve and confirm function

C.To trace the nerve's anatomical course

D.To aspirate fluid for cytology

Explanation: Intraoperative nerve monitoring using a spinal needle connected to a nerve stimulator allows the surgeon to identify and confirm the function of the recurrent laryngeal nerve. When electrical stimulation is applied to the nerve, it produces characteristic muscle responses in the vocal cords that can be detected. This helps prevent iatrogenic nerve injury during thyroid and parathyroid surgery.

7Which retractor is most appropriate for deep abdominal exposure during an open cholecystectomy?

A.Senn retractor

B.Army-Navy retractor

C.Bookwalter retractor

D.Weitlaner retractor

Explanation: The Bookwalter retractor is a table-mounted, self-retaining retractor system that provides excellent deep abdominal exposure for open procedures like cholecystectomy. It allows hands-free retraction with multiple interchangeable blades and is ideal for procedures requiring sustained exposure of deep structures. Smaller retractors like Senn or Army-Navy are for superficial wounds.

8What is the correct order for applying skin staples during wound closure?

A.Middle first, then alternating sides toward ends

B.One end to the other in continuous sequence

C.Place all staples loosely, then tighten sequentially

D.Both ends first, then fill in the middle

Explanation: When closing a wound with skin staples, the correct technique is to place the first staple at the midline of the wound, then alternate placing staples on each side, working toward both ends. This technique provides even wound approximation and prevents misalignment or bunching of the wound edges.

9What is the primary indication for using a running locked (continuous locked) suture pattern?

A.Cosmetic closures requiring minimal scarring

B.Hemostasis in vascular or bleeding tissues

C.Tendon repair requiring maximum strength

D.Bowel anastomosis to prevent leakage

Explanation: A running locked suture is primarily used when hemostasis is needed in vascular or bleeding tissues. The locking mechanism at each stitch provides better hemostasis than a simple running suture because each loop is secured and can apply compression to bleeding points. It is commonly used in areas like the scalp, muscle layers, and subcutaneous tissues with significant vascularity.

10During a laparoscopic procedure, the surgeon reports "loss of pneumoperitoneum." What is the first action the surgical first assistant should take?

A.Immediately convert to open procedure

B.Check all port site connections and tubing for leaks

C.Increase the insufflator pressure to maximum

D.Apply additional trocars to seal the abdomen

Explanation: When pneumoperitoneum is lost during laparoscopic surgery, the first step is to systematically check for leaks in the system. This includes verifying port site seals, checking tubing connections, ensuring trocar valves are functioning, and confirming the insufflator is operating properly. Many leaks are easily correctable without converting to open surgery.

About the CSFA Exam

The CSFA credential validates advanced perioperative competency for surgical first assistants. The exam covers preoperative patient preparation, intraoperative first assisting techniques including hemostasis and wound closure, postoperative care, administrative duties, equipment sterilization, anatomy and physiology, microbiology, and surgical pharmacology/anesthesia.

Questions

175 scored questions

Time Limit

4 hours

Passing Score

98/150 scored (65.3%)

Exam Fee

$300-400 (NBSTSA / Pearson VUE)

CSFA Exam Content Outline

6%

Preoperative Preparation

Patient assessment, surgical positioning, skin preparation, sterile field setup, surgical counts, and preoperative documentation

45.3%

Intraoperative Procedures

First assisting techniques, exposure and visualization, hemostasis, tissue handling, wound closure, suturing, stapling, and procedural assistance across surgical specialties

3.7%

Postoperative Procedures

Wound dressing, patient transfer, postoperative documentation, and discharge planning

4%

Administrative/Personnel

Professional practice, documentation, ethical standards, informed consent, scope of practice, and workplace compliance

10%

Equipment Sterilization/Maintenance

Sterilization methods, biological indicators, instrument care, and equipment troubleshooting

20.7%

Anatomy & Physiology

Surgical anatomy, body systems, and physiological implications in surgical procedures

3.3%

Microbiology

Pathogenic organisms, SSI prevention, sterility principles, and infection control

3.3%

Pharmacology/Anesthesia

Common surgical medications, anesthesia agents, and emergency pharmacology

How to Pass the CSFA Exam

What You Need to Know

Passing score: 98/150 scored (65.3%)
Exam length: 175 questions
Time limit: 4 hours
Exam fee: $300-400

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CSFA Study Tips from Top Performers

1Weight study heavily to Intraoperative Procedures (45%): master first assisting techniques, exposure methods, and tissue handling

2Focus on hemostasis: know when to use suture ligation, electrocautery, hemostatic agents, and tourniquets

3Learn wound closure techniques: layered closure, skin closure methods, and staple application/removal

4Understand anesthesia basics: general vs. regional, local anesthetics, and malignant hyperthermia recognition

5Review surgical pharmacology: vasoconstrictors, anticoagulants, reversal agents, and emergency medications

6Master surgical anatomy landmarks for all major body systems and specialties

Frequently Asked Questions

How many questions are on the CSFA exam?

The NBSTSA CSFA exam contains 175 total multiple-choice questions: 150 scored items and 25 unscored pretest items. You won't know which questions are pretest during the exam, so treat every question as scored.

What score do I need to pass the CSFA exam?

You must answer 98 of the 150 scored items correctly, which is approximately 65.3%. Results are typically available within 6 weeks of testing.

What are the prerequisites for CSFA certification?

Candidates must have completed a surgical first assistant program accredited by CAAHEP or ABHES, OR be a certified surgical technologist (CST) with additional first assistant training and case documentation. Check the NBSTSA handbook for current eligibility pathways.

What is the largest domain on the CSFA exam?

Intraoperative Procedures is by far the largest domain, accounting for approximately 45.3% of scored questions. Focus the majority of your study time on first assisting techniques, hemostasis, tissue handling, wound closure, and specialty procedures.

How should I prepare for the CSFA exam in 2026?

Use weighted preparation: (1) master first assisting techniques and tissue handling, (2) study advanced hemostasis methods, (3) learn wound closure techniques including suturing and stapling, (4) understand anesthesia considerations and emergency medications, and (5) review surgical anatomy for all major specialties.

What is the career outlook for surgical first assistants?

Surgical first assistants are in high demand with competitive salaries. CSFAs work alongside surgeons in hospital ORs, ambulatory surgical centers, and specialty clinics. The role offers advancement opportunities and typically higher compensation than surgical technologist positions.