The CFA exam is for surgical first assistants who have finished an accredited program and want national certification. This page gives you free practice sets by topic, worked explanations, a study plan, and the format, fees, passing score and retake rules taken from the official exam body.
The CFA has 175 questions, takes about 4 hours and costs $350[1][2][3] (National Board of Surgical Technology and Surgical Assisting, verified Oct 26, 2026).
Numbers in brackets link to the official sources listed under Sources & last verified. Dates that have passed are removed automatically.
| Item | Detail | Source · Verified |
|---|---|---|
| Number of questions | 175 multiple-choice questions (150 scored)[1] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Time limit | 4 hours[2] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Passing score | 99 correct out of 150 scored questions[1] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Exam fee | $350 first-time ($240 AST members)[3] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Retake fee | $310 per retake[3] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Retake policy | No waiting period; max 3 attempts per calendar year[4] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Validity | 2-year certification cycle[5] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Renewal | 38 CE credits + $45 (or re-exam $550)[5] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Delivery | Computer-based at PSI test centers, year-round[2] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Eligibility | Graduate of a CAAHEP-accredited surgical first assistant program[6] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Score release | About 48 business hours (PSI center students); test day for post-grads[2] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Registration opens | Rolling; 2–4 weeks processing ($85 rush = 3–5 business days)[3] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
| Testing window | By appointment, year-round (no fixed dates)[3] | National Board of Surgical Technology and Surgical Assisting · Oct 26, 2026 |
According to National Board of Surgical Technology and Surgical Assisting, “Total questions: 175 (150 scored, 25 unscored pretest questions)”[1]
The exam is run by the National Board of Surgical Technology and Surgical Assisting (NBSTSA), and its official materials call the credential the CSFA. It is meant for surgical first assistants who want a national certification. To be eligible, you must graduate from a CAAHEP-accredited surgical first assistant program.
The test is computer-based and given at PSI test centers year-round. There are no fixed exam dates. Each center keeps its own schedule, so you book an appointment. You get 4 hours to answer 175 multiple-choice questions. Of those, 150 are scored and the rest are unscored pretest questions. The passing score is 99 correct out of 150 scored questions.
The first-time exam fee is $350, or $240 for AST members. Allow 2-4 weeks for your application to be processed and your Authorization To Test to arrive. A rush fee of $85 brings processing to 3-5 business days. Scores usually arrive in about 48 business hours for PSI center students, and on test day for post-grads.
If you do not pass, you may reapply right away for $310 per retake, up to 3 exams in a calendar year. Certification runs on a 2-year cycle. Renewal takes 38 CE credits plus $45, or you can re-take the exam for $550. Fees and rules can change, so check nbstsa.org before you apply.
The content areas below are copied from the official CFA content outline published by National Board of Surgical Technology and Surgical Assisting. The right-hand column shows which of our practice sets covers it.
| Official content area | Practice on this site |
|---|---|
| Ancillary Duties[7] | CFA Operative Note Documentation Practise the paperwork and support tasks around a case, especially what belongs in an operative note and who is responsible for it. |
| Perioperative Care[7] | CFA Perioperative Assessment Practise assessing the patient before surgery and recognising problems early in recovery, then follow up with the postoperative complications set. |
Prepare for the CFA - Certified First Assist exam with our free practice test modules. Each quiz covers key topics to help you pass on your first try.
These are practice questions written for this site, not questions from the real exam. Each explanation shows why the right answer is right and why the others are wrong.
Question: Which postoperative complication most commonly causes fever on days 1–2 after surgery?
Answer: B. Atelectasis
Explanation:
The answer is atelectasis. After surgery, shallow breathing and retained secretions leave parts of the lung partly collapsed, and that is the usual source of a low-grade fever on days 1–2.
Pneumonia is a real concern, but it tends to develop later, once collapsed or infected lung has had time to progress. Pulmonary embolism can cause fever, but it is less common and usually comes with sudden breathlessness, chest pain or a fast heart rate. Pleural effusion is also a possible finding after surgery, yet it is not the most frequent early cause of fever.
Rule to remember: match the complication to its timing. Early fever points to the lungs not expanding well, so deep breathing, coughing and early movement are the standard preventive steps.
Question: Which of the following is a fundamental principle of first-assist surgical roles as it applies to Certified First Assist?
Answer: A. Systematic evaluation and adherence to established industry standards
Explanation:
The correct option is systematic evaluation and adherence to established industry standards. A first assistant works directly with the surgeon, so the role depends on consistent, checkable practice that other people can rely on.
Relying only on personal experience is wrong because experience without reference to guidelines produces variation between cases and cannot be audited. Putting speed ahead of accuracy and compliance is wrong because errors and shortcuts raise patient risk. Avoiding documentation is wrong because records are how care is verified, handed over and defended later.
Rule to remember: when an answer choice trades accuracy, standards or documentation for convenience, it is almost always the distractor. The best answer supports safety and consistency.
Question: In the context of sterile field management, what role does continuous professional development play for CFA practitioners?
Answer: B. It ensures practitioners remain current with evolving standards, technologies, and best practices
Explanation:
The correct option is that professional development keeps practitioners current with evolving standards, technologies and best practices. Sterile technique and the products used to support it change over time, so staying current is part of doing the job safely.
Calling it optional and only for career advancement is wrong because certification itself depends on ongoing learning. Saying it is required only in the first year of certification is wrong because the requirement continues for as long as you hold the credential. Describing it as mainly networking with no practical benefit is wrong because the point is maintaining competency, even if contacts are a side effect.
Rule to remember: answers that make learning optional, short-term or purely social rarely match how a certifying body thinks about competence.
Begin by reading the official content outline and the candidate handbook on the NBSTSA site, so you know what the exam covers and how it is run. Then take a practice set from each topic below without time pressure, and write down every question you miss or guessed.
Group your misses by topic rather than by set. If sterile field questions keep costing you, go back to that set and read each explanation, including the ones for the options you eliminated correctly. The wrong-answer reasoning is where the rules you need are stated most plainly.
In the last stretch, do longer mixed sessions to build the stamina for a long computer-based test. Keep in mind that our questions are written by us and are not real exam questions, so use them to find gaps in your understanding, not to predict what will appear.
You must have graduated from a CAAHEP-accredited surgical first assistant program. The exam body, NBSTSA, sets this requirement for its CSFA exam. Check the eligibility page on nbstsa.org for current details before you apply, since application rules can be updated.
The exam has 175 multiple-choice questions and lasts 4 hours. Of those, 150 are scored and the remaining questions are unscored pretest questions. You will not be told which ones are unscored, so treat every question as if it counts.
The passing score is 99 correct out of 150 scored questions. The unscored pretest questions do not count toward that total. Scores usually arrive in about 48 business hours for PSI center students, and on test day for post-grads.
The first-time fee is $350, or $240 for AST members. A retake costs $310. There is no waiting period before you reapply, but you are limited to 3 exams in a calendar year. Confirm current fees on nbstsa.org before paying.
The exam is given year-round at PSI test centers, by appointment, with no fixed dates. Each center keeps its own schedule. Allow 2-4 weeks for your application to be processed. A rush fee of $85 shortens that to 3-5 business days.
Certification runs on a 2-year cycle. To renew, complete 38 CE credits and pay a $45 application fee. The other route is to re-take the exam for $550. The NBSTSA renewals page lists the credit rules in full.
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