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NBSTSA CSFAFree Certified Surgical First Assistant practice test
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10 real NBSTSA CSFA practice questions with instant answers and explanations — no account, no credit card, no email. Score yourself, then unlock the full bank of 64 questions whenever you’re ready. The NBSTSA CSFA passing score is 98 / 150 scored questions (≈65%).
A certified surgical first assistant (CSFA) is preparing to participate in a right hemicolectomy. Before the surgeon makes the initial incision, the circulating nurse initiates the surgical time-out. The CSFA notices that the consent form specifies 'left hemicolectomy.' Which action should the CSFA take?
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Q1. A certified surgical first assistant (CSFA) is preparing to participate in a right hemicolectomy. Before the surgeon makes the initial incision, the circulating nurse initiates the surgical time-out. The CSFA notices that the consent form specifies 'left hemicolectomy.' Which action should the CSFA take?
Correct answer: B. Speak up immediately to halt the procedure and reconcile the discrepancy before proceeding
The surgical time-out is specifically designed to catch site, side, and procedure discrepancies before incision; every team member—including the CSFA—has both the authority and professional obligation to halt the procedure when a consent mismatch is identified. Proceeding despite a documented discrepancy (option C) violates patient safety standards and exposes the team to legal liability. Deferring to the surgeon's site mark alone (option A) is insufficient because the legal consent document controls the authorized procedure. Post-procedure notification (option D) is far too late to protect the patient from a wrong-site event.
Q2. During a laparoscopic cholecystectomy, the CSFA assists in placing a radiopaque clip on the cystic duct. At the close of the case, the scrub technician reports that the soft-goods count is correct but one medium hemoclip from the opened clip applier is unaccounted for. The circulating nurse and CSFA recount and agree the clip is missing. What is the CSFA's primary responsibility at this point?
Correct answer: A. Inform the surgeon of the count discrepancy so an intraoperative X-ray can be considered before the patient leaves the OR
A retained surgical item (RSI) safety protocol requires that any unresolved count discrepancy be communicated to the surgeon before the wound is closed, so an intraoperative radiograph can be obtained and the item located or accounted for. Documenting the count as correct when it is not (option C) constitutes falsification of the medical record and directly endangers the patient. Waiting until the PACU (option B) allows the patient to leave the OR with a potentially retained item. A second independent recount (option D) is appropriate as an initial step but cannot substitute for surgeon notification and imaging when the discrepancy persists.
Q3. A state's Medical Practice Act authorizes physicians to delegate intraoperative tasks to a CSFA under physician supervision. A hospital credentialing committee is reviewing whether to grant the CSFA privileges to perform fascial closure with a running suture under attending supervision. A committee member argues that the ACS statement on surgical assisting prohibits non-physician assistants from performing any suturing. Which response best reflects the current ACS position on surgical first assisting?
Correct answer: B. The ACS supports the role of qualified surgical first assistants who perform intraoperative tasks, including suturing, under direct supervision of the responsible surgeon
The American College of Surgeons (ACS) Statement on the Surgeon's Responsibility in the Supervision of Surgical Team Members affirms that qualified surgical first assistants—including CSFAs—may perform intraoperative tasks such as suturing, retraction, and hemostasis when acting under the direct supervision of the responsible surgeon. The ACS statement does not categorically prohibit suturing by non-physician assistants (option A); rather, it ties permissibility to supervision and credentialing. The ACS does not restrict first-assistant roles to PAs or APRNs exclusively (option C). The ACS does maintain its own position statement and does not defer entirely to the Joint Commission (option D).
Q4. During a scheduled open colectomy, the colon is entered and spillage of intestinal contents occurs before the anastomosis is complete. The surgical first assistant assists in irrigating the wound thoroughly before closure. Using the National Research Council wound classification system, which class should this wound be assigned, and what does it indicate about SSI risk?
Correct answer: C. Class III (contaminated) — gross spillage from the gastrointestinal tract with SSI risk of 13–20%
Gross spillage of intestinal contents into the operative field classifies the wound as Class III (contaminated), which carries an SSI risk of approximately 13–20%. Class II applies only when the GI tract is entered in a controlled manner without significant spillage (e.g., elective bowel resection with no leakage). Class IV requires pre-existing infection or a perforated viscus with purulent material, which is not described here. Class I wounds have no hollow-viscus entry at all.
Q5. A patient undergoing a total knee arthroplasty develops a surgical-site infection two weeks postoperatively. The wound culture grows gram-positive cocci in clusters that test positive for coagulase and are resistant to oxacillin. Which organism is the most likely causative pathogen, and what is the primary source of this organism in the perioperative environment?
Correct answer: C. Methicillin-resistant Staphylococcus aureus (MRSA), typically originating from the patient's own nasal or skin flora
Gram-positive cocci in clusters that are coagulase-positive and oxacillin-resistant identify MRSA. Studies consistently show the patient's own nares and skin colonization as the dominant reservoir for MRSA SSIs following orthopedic procedures; nasal decolonization with mupirocin plus chlorhexidine bathing pre-operatively is the evidence-based prevention strategy. Staphylococcus epidermidis is coagulase-negative, not coagulase-positive. Streptococcus pyogenes is gram-positive but appears in chains and is not oxacillin-resistant in the manner described. Clostridium perfringens is a gram-positive rod, not cocci, and is an anaerobe associated with traumatic or soil-contaminated wounds.
Q6. After completion of a neurosurgical procedure, the scrub technician discovers that a dural patch was processed using high-level disinfection rather than sterilization. The surgeon is concerned about potential prion transmission. Which statement BEST explains why high-level disinfection is inadequate for instruments or implants with prion-contamination risk?
Correct answer: B. Prions are misfolded proteins that lack nucleic acid and are not inactivated by standard glutaraldehyde or hydrogen peroxide-based high-level disinfectants; complete inactivation requires extended autoclaving at 134°C or sodium hydroxide treatment
Prions are proteinaceous infectious particles composed entirely of abnormally folded host protein with no nucleic acid; they are extraordinarily resistant to conventional chemical disinfectants, UV radiation, and standard steam sterilization cycles. The WHO and CDC recommend either single-use instruments, prolonged gravity-displacement autoclaving at 134°C for 18 minutes (or 132°C for 1 hour), or immersion in 1 N NaOH for prion decontamination. Extended contact with glutaraldehyde or hydrogen peroxide does NOT achieve prion inactivation, making option C incorrect. Prions are not endospores (eliminating A) and are not enveloped RNA viruses (eliminating D).
Q7. During morning setup, the scrub technician opens a wrapped instrument tray and finds the external chemical indicator tape has turned from beige to the manufacturer's specified dark brown color. The tray was autoclaved three days ago and stored in a closed cabinet in the clean core. Which action is most appropriate?
Correct answer: D. Inspect the internal chemical indicator before deciding whether to proceed
External chemical indicators confirm that the package was exposed to sterilization conditions but do not verify that internal load conditions were adequate; an internal chemical indicator (Type 5 integrating or Type 6 emulating indicator) placed inside the tray provides evidence of conditions at the instrument level. The external indicator color change alone is insufficient to release the tray for use. Event-related sterility means the package remains sterile until an event (moisture, compromised packaging, handling error) compromises it, but reviewing the internal indicator is the correct first step before use. Re-processing without first checking the internal indicator is premature.
Q8. A surgical team must sterilize a heat-sensitive flexible laparoscopic camera head before an urgent case. The only available sterilization options in the department are a steam autoclave set to 132°C gravity cycle and a hydrogen peroxide gas plasma (HPGP) sterilizer. Which choice is correct and why?
Correct answer: B. Use the HPGP sterilizer because it operates at low temperature and is compatible with most heat-sensitive optics
Hydrogen peroxide gas plasma sterilization operates at approximately 45–55°C, making it the method of choice for heat-sensitive devices such as camera heads, flexible endoscopes with electronic components, and powered optics that cannot withstand steam temperatures. Steam at either 132°C or 121°C would destroy heat-sensitive optics and void manufacturer warranties. Twenty-minute glutaraldehyde exposure achieves only high-level disinfection, not sterility, and is insufficient for instruments entering a sterile field in a body cavity.
Q9. A Bowie-Dick test is run in the steam autoclave each morning before the first patient load. Today's test sheet shows an uneven color change — the center of the test sheet did not convert while the periphery did. What is the correct interpretation and action?
Correct answer: B. The result indicates a failed test; remove the sterilizer from service and notify biomedical engineering
An uneven or incomplete color change on the Bowie-Dick (air removal) test indicates inadequate air removal from the chamber, which creates cold spots that prevent steam penetration and reliable sterilization. A single failed Bowie-Dick test requires immediate removal of the sterilizer from service; a second run is not required before taking action. Biological indicator results do not rescue a failed Bowie-Dick test because they measure organism kill, not air elimination efficiency, which is what this test specifically assesses.
Q10. An instrument tray containing a cemented total hip implant is designated for immediate-use steam sterilization (IUSS) because the implant was dropped on the field mid-case. Which statement reflects current AORN and AAMI guidelines regarding this situation?
Correct answer: B. IUSS should not be routinely used for implants; a biological indicator must be included and results reviewed before implanting when time permits
AORN and AAMI ST79 guidelines state that IUSS should not be used routinely for implants because there is no opportunity to quarantine the load pending biological indicator (BI) results. When IUSS is used for an implant in an urgent, unavoidable situation, a BI must be included in the cycle and the result documented; the team should wait for the BI result when time permits. Using a Class 5 indicator does not replace BI monitoring for implants. Steam is not contraindicated for metallic implants in general — it is the preferred method for most surgical metal instruments.
Exam facts and objectives sourced from the official NBSTSA certification page. Last reviewed June 2026.
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