Certified Surgical Assistant (Csa) Certification
Practice Exam 2025/2026 | Real Questions With
Answers & Rationales
SECTION 1: PREOPERATIVE CARE
1. A 65-year-old patient is scheduled for an elective right hemicolectomy. The
patient reports taking clopidogrel 75 mg daily for a history of coronary stents.
When should this medication be discontinued prior to surgery?
• A) 24 hours before surgery
• B) 48 hours before surgery
• C) 5–7 days before surgery
• D) 14 days before surgery
Correct Answer: C
Rationale: Clopidogrel (P2Y12 inhibitor) should be discontinued 5–7 days before
elective surgery to allow adequate platelet function recovery. Aspirin may be
continued in patients with drug-eluting stents if the risk of cardiac events
outweighs bleeding risk .
2. Which of the following is the appropriate legal doctrine when an unconscious
patient requires emergency surgery and no surrogate decision-maker is
available?
• A) Express consent
• B) Implied consent
• C) Informed consent
• D) Surrogate consent
,Correct Answer: B
Rationale: Implied consent applies in emergency situations when the patient is
unable to consent and no surrogate is available. The law presumes a reasonable
person would consent to life-saving treatment .
3. Which of the following findings on preoperative assessment most significantly
increases the risk of surgical site infection?
• A) Hemoglobin 11.5 g/dL
• B) Blood glucose 220 mg/dL
• C) White blood cell count 8,000/µL
• D) Platelet count 280,000/µL
Correct Answer: B
Rationale: Hyperglycemia (blood glucose >180 mg/dL) is an independent risk
factor for surgical site infections and poor wound healing. Elevated glucose
impairs immune function and increases infection risk .
4. A patient is scheduled for a total knee arthroplasty and has a known history
of MRSA nasal colonization. Which preoperative intervention is most
appropriate?
• A) Standard antibiotic prophylaxis only
• B) Decolonization with mupirocin nasal ointment and chlorhexidine
gluconate baths
• C) Delaying surgery for 6 weeks
• D) Using a higher dose of standard antibiotics
Correct Answer: B
Rationale: MRSA decolonization protocols are recommended for patients known to
be colonized. Decolonization reduces the bacterial load and lowers the risk of
surgical site infections .
, 5. A patient is scheduled for surgery and has a known allergy to latex. Which of
the following is the MOST appropriate action for the surgical team to take?
• A) Proceed with standard latex gloves as the allergy is minor
• B) Administer antihistamines preoperatively to prevent a reaction
• C) Use only latex-free products in the operating room and on the patient
• D) Avoid any skin contact with the patient's skin
Correct Answer: C
Rationale: A confirmed latex allergy requires complete avoidance of all latex-
containing products in the operative environment. The OR should be prepared as a
"latex-safe" environment prior to the patient's arrival .
6. A patient is NPO for 8 hours before surgery but reports having a cup of black
coffee 2 hours before the scheduled surgery time. The surgical assistant should:
• A) Proceed as the coffee is a clear liquid
• B) Notify the surgeon and anesthesiologist immediately
• C) Document the patient's statement and proceed
• D) Tell the patient it is acceptable to have clear liquids
Correct Answer: B
Rationale: NPO guidelines typically prohibit clear liquids 2 hours before surgery.
The surgical team must be notified of any deviation from NPO status to assess the
risk of aspiration and potentially delay the procedure .
SECTION 2: GENERAL SURGERY (Questions 7-14)
7. During an abdominal laparotomy, which anatomical layer provides the
greatest tensile strength and is most critical for secure closure to prevent
incisional hernia?
• A) Skin
Practice Exam 2025/2026 | Real Questions With
Answers & Rationales
SECTION 1: PREOPERATIVE CARE
1. A 65-year-old patient is scheduled for an elective right hemicolectomy. The
patient reports taking clopidogrel 75 mg daily for a history of coronary stents.
When should this medication be discontinued prior to surgery?
• A) 24 hours before surgery
• B) 48 hours before surgery
• C) 5–7 days before surgery
• D) 14 days before surgery
Correct Answer: C
Rationale: Clopidogrel (P2Y12 inhibitor) should be discontinued 5–7 days before
elective surgery to allow adequate platelet function recovery. Aspirin may be
continued in patients with drug-eluting stents if the risk of cardiac events
outweighs bleeding risk .
2. Which of the following is the appropriate legal doctrine when an unconscious
patient requires emergency surgery and no surrogate decision-maker is
available?
• A) Express consent
• B) Implied consent
• C) Informed consent
• D) Surrogate consent
,Correct Answer: B
Rationale: Implied consent applies in emergency situations when the patient is
unable to consent and no surrogate is available. The law presumes a reasonable
person would consent to life-saving treatment .
3. Which of the following findings on preoperative assessment most significantly
increases the risk of surgical site infection?
• A) Hemoglobin 11.5 g/dL
• B) Blood glucose 220 mg/dL
• C) White blood cell count 8,000/µL
• D) Platelet count 280,000/µL
Correct Answer: B
Rationale: Hyperglycemia (blood glucose >180 mg/dL) is an independent risk
factor for surgical site infections and poor wound healing. Elevated glucose
impairs immune function and increases infection risk .
4. A patient is scheduled for a total knee arthroplasty and has a known history
of MRSA nasal colonization. Which preoperative intervention is most
appropriate?
• A) Standard antibiotic prophylaxis only
• B) Decolonization with mupirocin nasal ointment and chlorhexidine
gluconate baths
• C) Delaying surgery for 6 weeks
• D) Using a higher dose of standard antibiotics
Correct Answer: B
Rationale: MRSA decolonization protocols are recommended for patients known to
be colonized. Decolonization reduces the bacterial load and lowers the risk of
surgical site infections .
, 5. A patient is scheduled for surgery and has a known allergy to latex. Which of
the following is the MOST appropriate action for the surgical team to take?
• A) Proceed with standard latex gloves as the allergy is minor
• B) Administer antihistamines preoperatively to prevent a reaction
• C) Use only latex-free products in the operating room and on the patient
• D) Avoid any skin contact with the patient's skin
Correct Answer: C
Rationale: A confirmed latex allergy requires complete avoidance of all latex-
containing products in the operative environment. The OR should be prepared as a
"latex-safe" environment prior to the patient's arrival .
6. A patient is NPO for 8 hours before surgery but reports having a cup of black
coffee 2 hours before the scheduled surgery time. The surgical assistant should:
• A) Proceed as the coffee is a clear liquid
• B) Notify the surgeon and anesthesiologist immediately
• C) Document the patient's statement and proceed
• D) Tell the patient it is acceptable to have clear liquids
Correct Answer: B
Rationale: NPO guidelines typically prohibit clear liquids 2 hours before surgery.
The surgical team must be notified of any deviation from NPO status to assess the
risk of aspiration and potentially delay the procedure .
SECTION 2: GENERAL SURGERY (Questions 7-14)
7. During an abdominal laparotomy, which anatomical layer provides the
greatest tensile strength and is most critical for secure closure to prevent
incisional hernia?
• A) Skin
