Free Practice Questions for NASC CRNFA

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Key Facts: NASC CRNFA Exam

150

Total Questions

NASC CRNFA Handbook

3 hours

Exam Time

NASC CRNFA Handbook

$425

Exam Fee

NASC fee schedule

ABSNC

Accreditation

ABSNC accreditation directory

5 years

Certification Valid

NASC recertification policy

CNOR

Prerequisite Credential

NASC eligibility criteria

PSI

Test Provider

NASC scheduling info

NASC CRNFA is an ABSNC-accredited specialty certification (formerly administered by CCI/Competency & Credentialing Institute) for the perioperative RN First Assistant. The exam contains 150 multiple-choice items delivered in 3 hours through PSI. Eligibility requires a current RN license, a CRNFA program completion or equivalent, CNOR certification, and documented first-assist experience. The credential is distinct from CNOR (which validates the perioperative circulating/scrub RN role) and from the surgical PA-First-Assist scope.

Sample NASC CRNFA Practice Questions

Try these sample questions to review concepts for the NASC CRNFA exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1While reviewing a surgical patient's H&P the night before a planned hemicolectomy, the RNFA notes the patient is taking warfarin 5 mg daily. What is the most appropriate first-assist action?

A.Hold the dose and document only

B.Verify with the surgeon and anesthesia provider that an INR has been drawn and a bridging plan exists

C.Cancel the case and reschedule

D.Tell the patient to stop the warfarin immediately

Explanation: Anticoagulants directly affect intraoperative bleeding and the first assistant's hemostasis plan. Confirming the INR and the bridging plan with the surgeon and anesthesia is the correct preoperative coordination role for the RNFA. Holding doses or telling the patient to stop without orders is outside scope.

2An ASA Physical Status Classification of ASA III on a preoperative patient indicates which of the following?

A.A normal healthy patient

B.A patient with mild systemic disease

C.A patient with severe systemic disease that is not incapacitating

D.A moribund patient not expected to survive without surgery

Explanation: ASA III describes a patient with severe systemic disease (for example, poorly controlled diabetes or stable angina) that limits activity but is not incapacitating. ASA I is healthy, ASA II is mild systemic disease, ASA IV is severe disease that is a constant threat to life, and ASA V is moribund.

3Which preoperative laboratory result would most likely cause the RNFA to alert the surgeon to delay an elective right knee total joint replacement?

A.Hemoglobin 13.8 g/dL

B.Platelet count 38,000/microliter

C.Sodium 138 mEq/L

D.Creatinine 0.9 mg/dL

Explanation: A platelet count of 38,000/microliter is severe thrombocytopenia and creates a major bleeding risk for an orthopedic case where bone bleeding is expected. The other values are within or near normal range. Severe thrombocytopenia generally warrants postponement, hematology consult, or platelet transfusion before elective surgery.

4Per The Joint Commission Universal Protocol, who must perform surgical site marking?

A.The circulating nurse before the patient enters the OR

B.The licensed practitioner who is accountable for the procedure, ideally with the patient involved and awake

C.The RNFA on behalf of the surgeon if the surgeon is delayed

D.The OR aide before transport

Explanation: The Universal Protocol requires that the licensed independent practitioner who is accountable for the procedure mark the site, with the patient involved when possible. The RNFA does not own this step. The mark must be unambiguous, made with a permanent marker, visible after prep and draping, and used for laterality, multiple structures, or multiple levels.

5During the surgical timeout for a laparoscopic cholecystectomy, the RNFA must verify which set of elements?

A.Correct patient, correct procedure, correct site, and any implants/special equipment

B.Correct patient and correct surgeon only

C.Insurance authorization and consent

D.Surgeon's lunch break schedule and OR turnover plan

Explanation: The Universal Protocol timeout, immediately before incision, verifies correct patient, correct procedure, correct site, and the availability of any implants, blood products, antibiotics, or special equipment. All team members stop and actively participate.

6A patient with a documented latex allergy is scheduled for an exploratory laparotomy. What is the most important preoperative action by the RNFA?

A.Schedule the case last on the day's list

B.Coordinate with the team to ensure a latex-safe environment and instrumentation set-up before the patient enters the room

C.Premedicate the patient with diphenhydramine

D.Apply only powdered gloves to reduce aerosolized latex

Explanation: Latex-allergic patients should be the first case of the day in a latex-safe room with all latex-containing items removed in advance. The RNFA contributes to the team plan by verifying that gloves, drains, Foley catheters, and tourniquets used are latex-free. Powdered gloves increase aerosolized latex exposure.

7Which finding on a preoperative chest X-ray most directly affects the RNFA's intraoperative plan for a thoracic procedure?

A.Mild costochondral calcification

B.A 3 cm right upper lobe mass with adjacent atelectasis

C.Old healed rib fracture

D.Aortic knob calcification

Explanation: A mass with atelectasis impacts the surgical approach, retractor selection, lung isolation strategy, and specimen handling expectations. The other findings are incidental in most adults and do not change first-assist setup.

8For an elective open abdominal hernia repair on a 70 kg adult, which antibiotic prophylaxis timing is correct per current SCIP/CMS guidance?

A.Cefazolin within 60 minutes before incision

B.Cefazolin within 4 hours before incision

C.Vancomycin within 30 minutes before incision

D.No prophylaxis needed for clean abdominal cases

Explanation: Standard surgical antibiotic prophylaxis must be infused within 60 minutes before incision. Vancomycin and fluoroquinolones, because of longer infusion times, are allowed within 120 minutes before incision. Hernia repair is clean but mesh is implanted, so prophylaxis is recommended.

9When reviewing surgical anatomy with the team for a planned right hemicolectomy, which vessel is most critical to identify and protect?

A.Inferior mesenteric artery

B.Ileocolic artery and right colic branch of the superior mesenteric artery

C.Splenic artery

D.Left gastric artery

Explanation: A right hemicolectomy ligates the ileocolic artery and the right colic branch of the SMA. Knowing the relevant vascular pedicle is essential for first-assist exposure, retraction, and anticipating clamping or stapling. The IMA, splenic, and left gastric arteries are not in this surgical field.

10Per AORN guidance and Caprini risk stratification, a patient with a Caprini score of 8 going to a 4-hour pelvic surgery should have which DVT prophylaxis plan?

A.Mechanical only (sequential compression devices)

B.No prophylaxis

C.Combined mechanical and pharmacologic prophylaxis (e.g., low-dose heparin or LMWH plus SCDs) unless contraindicated

D.Aspirin 81 mg daily only

Explanation: A Caprini score of 8 indicates high risk for venous thromboembolism. Combined mechanical and pharmacologic prophylaxis is recommended unless bleeding risk contraindicates it. SCDs alone or aspirin alone are inadequate for this risk tier.

About the NASC CRNFA Exam

The CRNFA credential validates that an experienced perioperative RN can perform the role of first assistant to the surgeon under the state nurse practice act and AORN RN First Assistant standards. The exam covers preoperative assessment, intraoperative tissue handling and hemostasis, suturing and wound closure, surgical procedures across specialties, postoperative care, OR safety, and professional scope of practice.

Exam sponsor: NASC (National Assistant at Surgery Certification). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

150 questions

Time Limit

3 hours

Passing Score

Scaled passing score set by NASC

Exam / Certification Fees

$425

Exam sponsor website

Reported exam pass rate: Not published. NASC does not publicly publish first-time pass rates Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

15%

Preoperative Assessment & Planning

H&P interpretation, ASA classification, lab/imaging review, anatomy review for the planned procedure, surgical site marking, and Universal Protocol participation

30%

Intraoperative Role of the First Assistant

Sterile technique, tissue handling and retraction, suction and sponging, hemostasis (electrocautery, ligatures, clips, staples), suturing techniques, needle and suture material selection, knot tying, and surgical instrumentation

20%

Specific Surgical Procedures

First-assist responsibilities for laparoscopic vs open abdominal, robotic (port placement, docking), orthopedic, CV/thoracic, GU, GYN, ENT, plastic, and vascular procedures

10%

Anatomy & Surgical Pathology

Surgical anatomy by region and recognition of common surgical pathology including macroscopic features of cancer staging

10%

Postoperative Care

Wound closure types (primary, secondary, tertiary intention), drains (Penrose, JP, Hemovac, chest tubes), dressings, postoperative orders, and complication recognition

10%

Patient Safety, Equipment & Regulatory

Universal Protocol, surgical counts, specimen handling, fire safety, electrosurgery (ESU/Bovie) safety, MH protocol, normothermia, antibiotic and DVT prophylaxis

Professional Role, Scope & Ethics

RNFA scope under the state nurse practice act, AORN Standards and Position Statement on RN First Assistants, CMS billing modifiers, and ethical practice

Preparing for the NASC CRNFA Exam

What You Need to Know

Passing score: Scaled passing score set by NASC
Exam length: 150 questions
Time limit: 3 hours
Exam / certification fees: $425 Official sources

Using Our Practice Resources

Work through all 100 available questions
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NASC CRNFA: Suggested Study Strategy

1Memorize suture absorption timelines and indications - Vicryl, Monocryl, PDS, chromic gut, silk, Prolene, Ethibond

2Know the difference between cutting, taper, and blunt needles and when each is appropriate

3Practice OR safety scenarios - MH protocol (dantrolene 2.5 mg/kg), antibiotic timing (within 60 min, vanc/fluoroquinolones within 120 min), and normothermia targets

4Review AORN Standards and the AORN Position Statement on the RN First Assistant

5Understand the difference between RNFA and PA-First-Assist scope and the corresponding CMS modifiers (-80, -82, -AS)

6Drill sterile technique breaches, surgical counts (initial, closing, cavity), and fire triangle scenarios

Frequently Asked Questions

How many questions are on the NASC CRNFA exam?

The CRNFA exam contains 150 multiple-choice questions delivered in a 3-hour proctored session through PSI. NASC sets the passing scaled score; the exact cut score is not published.

Who administers the CRNFA exam now?

The CRNFA credential is administered by NASC (National Assistant at Surgery Certification). It was previously administered through CCI (Competency & Credentialing Institute), the same body that maintains CNOR. NASC continues to honor the ABSNC-accredited credential.

What are the eligibility requirements for CRNFA?

Candidates must hold a current unrestricted RN license, current CNOR certification, and have completed an accredited RN First Assistant program. Documented first-assist experience hours and a baccalaureate degree (or equivalent) are also required per NASC eligibility criteria.

How is CRNFA different from CNOR?

CNOR validates the circulating/scrub perioperative RN role. CRNFA validates the RN First Assistant role: tissue handling, retraction, hemostasis, suturing, and wound closure under the surgeon. CRNFA candidates must already hold CNOR before sitting for the CRNFA exam.

How is CRNFA different from a surgical PA-First-Assist?

An RNFA practices under the state nurse practice act and AORN standards as a registered nurse. A PA-First-Assist (PA-C) practices under a physician supervision agreement and the medical practice act. Billing modifiers and documentation requirements differ.

How long is CRNFA certification valid?

CRNFA certification is valid for 5 years and recertified through documented continuing education and intraoperative first-assist hours, or by re-examination, per NASC recertification policy.

What suture knowledge is tested on CRNFA?

Candidates should know absorbable materials (Vicryl ~70 days, Monocryl ~90-100 days, PDS ~180 days, chromic gut ~28 days), non-absorbable materials (silk, Prolene, Ethibond), needle types (cutting, taper, blunt), and the indications for simple, running, mattress, continuous, interrupted, and subcuticular techniques.