Certified Surgical First Assistant CSFA Exam 2026 Latest
Comprehensive Study Guide with Practice Questions
Surgical First Assisting Review, Detailed Rationales,
Verified Answers, Success Workbook
SECTION 1: PREOPERATIVE PREPARATION — DOMAIN IA (Questions
1-15)
1. A surgical first assistant is preparing for a procedure. According to the
Universal Protocol, which three elements must be verbally confirmed by the
entire surgical team during the "Time-Out" immediately before incision?
A) Patient name, date of birth, and medical record number
B) Correct patient identity, correct surgical site/side, and correct procedure
C) Surgeon name, anesthesiologist name, and circulating nurse name
D) Consent form signed, allergies verified, and NPO status confirmed
Rationale: The correct answer is B) Correct patient identity, correct surgical
site/side, and correct procedure. The Universal Protocol requires that the entire
surgical team pauses immediately before incision to verbally confirm the correct
patient identity, correct surgical site/side, and correct procedure. This "Time-Out"
is a critical patient safety measure designed to prevent wrong-patient, wrong-site,
and wrong-procedure errors. While other information such as consent and allergies
is also verified, the three required elements of the Time-Out are patient identity,
site/side, and procedure.
2. A surgical first assistant is preparing the operating room for a procedure.
The recommended temperature range for the operating room is:
A) 60-65°F (15-18°C)
B) 68-73°F (20-23°C)
C) 75-80°F (24-27°C)
D) 80-85°F (27-29°C)
Rationale: The correct answer is B) 68-73°F (20-23°C) . The recommended
temperature range for an operating room is 68-73°F (20-23°C). This temperature
range balances patient comfort (reducing the risk of hypothermia) with staff
,comfort and the need to minimize bacterial growth. Humidity should be
maintained at 20-60%. The surgical first assistant should verify and maintain the
appropriate environment according to the surgical procedure.
3. A patient is scheduled for a lower abdominal surgery. Which surgical
position is MOST appropriate for this procedure?
A) Prone position
B) Supine position
C) Lithotomy position
D) Lateral position
Rationale: The correct answer is B) Supine position. The supine position (lying
flat on the back) is the most common surgical position and is appropriate for lower
abdominal surgeries, as it provides optimal access to the abdominal region. The
prone position is used for posterior approaches, lithotomy for gynecological and
urological procedures, and lateral for thoracic, renal, and orthopedic procedures
such as total hip arthroplasty. The surgical first assistant participates in
coordinating and positioning the patient.
4. A surgical first assistant is preparing the sterile field. What is the correct
sequence for donning (putting on) personal protective equipment (PPE)
before a sterile procedure?
A) Gloves, gown, mask, eyewear
B) Mask, eyewear, gown, gloves
C) Gown, mask, eyewear, gloves
D) Eyewear, mask, gloves, gown
Rationale: The correct answer is C) Gown, mask, eyewear, gloves. The correct
sequence for donning PPE before a sterile procedure is: (1) gown, (2) mask, (3)
eyewear or face shield, and (4) gloves. This sequence minimizes contamination
and ensures that gloves are the last item to be put on. Gloves are donned last to
allow for touching other PPE without contamination. The surgical first assistant
must also perform a surgical hand scrub before gowning and gloving.
,5. A surgical first assistant is preparing the skin for surgery. Which of the
following is the CORRECT technique for applying the antiseptic solution?
A) Back-and-forth strokes from the periphery toward the incision site
B) Circular motion from the incision site outward
C) Back-and-forth strokes from the incision site outward
D) Random application with no specific pattern
Rationale: The correct answer is B) Circular motion from the incision site
outward. The correct technique for skin preparation involves applying the
antiseptic solution using a circular motion starting at the incision site and moving
outward toward the periphery. This technique prevents the recontamination of the
prepared area by moving bacteria away from the surgical site. The surgical first
assistant should utilize appropriate skin preparation techniques.
6. A patient has a documented allergy to latex. Which of the following actions
is MOST appropriate for the surgical first assistant?
A) Proceed with standard latex-containing supplies
B) Use only latex-free supplies and equipment
C) Administer antihistamines before the procedure
D) Cancel the procedure
Rationale: The correct answer is B) Use only latex-free supplies and equipment.
Patients with a documented latex allergy require latex-free precautions throughout
the perioperative period. This includes using latex-free gloves, drapes, catheters,
and all other supplies. The surgical first assistant should verify the allergy and
ensure all supplies are latex-free before the procedure begins. Failure to
accommodate a latex allergy can result in a severe allergic reaction, including
anaphylaxis.
7. During the preoperative phase, the surgical first assistant should verify the
operative consent and other pertinent information. Which of the following
should be reviewed?
A) Only the operative consent
B) History and physical, advanced directives, laboratory results, and
diagnostic results
, C) Only the patient's name and date of birth
D) Only the surgical procedure
Rationale: The correct answer is B) History and physical, advanced directives,
laboratory results, and diagnostic results. The surgical first assistant should
verify the operative consent and other pertinent information, including the history
and physical, advanced directives, laboratory results, and diagnostic results. The
assistant should also review the patient's medical chart and associated
documentation. This comprehensive review ensures patient safety and helps
anticipate the needs of the surgical team.
8. A surgical first assistant is preparing to insert a Foley urinary bladder
catheter. Which of the following is a key consideration for this procedure?
A) Use sterile technique only
B) Use sterile technique, verify catheter size, and inflate the balloon with the
correct volume of sterile water
C) Insert the catheter without any lubrication
D) Insert the catheter and inflate the balloon immediately
Rationale: The correct answer is B) Use sterile technique, verify catheter size,
and inflate the balloon with the correct volume of sterile water. When inserting
a Foley catheter, the surgical first assistant must use sterile technique, verify the
appropriate catheter size, and inflate the balloon with the correct volume of sterile
water. The catheter should be lubricated before insertion, and the balloon should
only be inflated after urine return is confirmed to verify placement in the bladder.
9. A patient is scheduled for surgery and has a history of diabetes. Which of
the following is a priority preoperative consideration for this patient?
A) Ensuring the patient has eaten a full meal
B) Monitoring and managing blood glucose levels
C) Administering a sedative
D) Placing the patient in the Trendelenburg position
Rationale: The correct answer is B) Monitoring and managing blood glucose
levels. For diabetic patients undergoing surgery, monitoring and managing blood
glucose levels is a priority to prevent hyperglycemia or hypoglycemia during the
Comprehensive Study Guide with Practice Questions
Surgical First Assisting Review, Detailed Rationales,
Verified Answers, Success Workbook
SECTION 1: PREOPERATIVE PREPARATION — DOMAIN IA (Questions
1-15)
1. A surgical first assistant is preparing for a procedure. According to the
Universal Protocol, which three elements must be verbally confirmed by the
entire surgical team during the "Time-Out" immediately before incision?
A) Patient name, date of birth, and medical record number
B) Correct patient identity, correct surgical site/side, and correct procedure
C) Surgeon name, anesthesiologist name, and circulating nurse name
D) Consent form signed, allergies verified, and NPO status confirmed
Rationale: The correct answer is B) Correct patient identity, correct surgical
site/side, and correct procedure. The Universal Protocol requires that the entire
surgical team pauses immediately before incision to verbally confirm the correct
patient identity, correct surgical site/side, and correct procedure. This "Time-Out"
is a critical patient safety measure designed to prevent wrong-patient, wrong-site,
and wrong-procedure errors. While other information such as consent and allergies
is also verified, the three required elements of the Time-Out are patient identity,
site/side, and procedure.
2. A surgical first assistant is preparing the operating room for a procedure.
The recommended temperature range for the operating room is:
A) 60-65°F (15-18°C)
B) 68-73°F (20-23°C)
C) 75-80°F (24-27°C)
D) 80-85°F (27-29°C)
Rationale: The correct answer is B) 68-73°F (20-23°C) . The recommended
temperature range for an operating room is 68-73°F (20-23°C). This temperature
range balances patient comfort (reducing the risk of hypothermia) with staff
,comfort and the need to minimize bacterial growth. Humidity should be
maintained at 20-60%. The surgical first assistant should verify and maintain the
appropriate environment according to the surgical procedure.
3. A patient is scheduled for a lower abdominal surgery. Which surgical
position is MOST appropriate for this procedure?
A) Prone position
B) Supine position
C) Lithotomy position
D) Lateral position
Rationale: The correct answer is B) Supine position. The supine position (lying
flat on the back) is the most common surgical position and is appropriate for lower
abdominal surgeries, as it provides optimal access to the abdominal region. The
prone position is used for posterior approaches, lithotomy for gynecological and
urological procedures, and lateral for thoracic, renal, and orthopedic procedures
such as total hip arthroplasty. The surgical first assistant participates in
coordinating and positioning the patient.
4. A surgical first assistant is preparing the sterile field. What is the correct
sequence for donning (putting on) personal protective equipment (PPE)
before a sterile procedure?
A) Gloves, gown, mask, eyewear
B) Mask, eyewear, gown, gloves
C) Gown, mask, eyewear, gloves
D) Eyewear, mask, gloves, gown
Rationale: The correct answer is C) Gown, mask, eyewear, gloves. The correct
sequence for donning PPE before a sterile procedure is: (1) gown, (2) mask, (3)
eyewear or face shield, and (4) gloves. This sequence minimizes contamination
and ensures that gloves are the last item to be put on. Gloves are donned last to
allow for touching other PPE without contamination. The surgical first assistant
must also perform a surgical hand scrub before gowning and gloving.
,5. A surgical first assistant is preparing the skin for surgery. Which of the
following is the CORRECT technique for applying the antiseptic solution?
A) Back-and-forth strokes from the periphery toward the incision site
B) Circular motion from the incision site outward
C) Back-and-forth strokes from the incision site outward
D) Random application with no specific pattern
Rationale: The correct answer is B) Circular motion from the incision site
outward. The correct technique for skin preparation involves applying the
antiseptic solution using a circular motion starting at the incision site and moving
outward toward the periphery. This technique prevents the recontamination of the
prepared area by moving bacteria away from the surgical site. The surgical first
assistant should utilize appropriate skin preparation techniques.
6. A patient has a documented allergy to latex. Which of the following actions
is MOST appropriate for the surgical first assistant?
A) Proceed with standard latex-containing supplies
B) Use only latex-free supplies and equipment
C) Administer antihistamines before the procedure
D) Cancel the procedure
Rationale: The correct answer is B) Use only latex-free supplies and equipment.
Patients with a documented latex allergy require latex-free precautions throughout
the perioperative period. This includes using latex-free gloves, drapes, catheters,
and all other supplies. The surgical first assistant should verify the allergy and
ensure all supplies are latex-free before the procedure begins. Failure to
accommodate a latex allergy can result in a severe allergic reaction, including
anaphylaxis.
7. During the preoperative phase, the surgical first assistant should verify the
operative consent and other pertinent information. Which of the following
should be reviewed?
A) Only the operative consent
B) History and physical, advanced directives, laboratory results, and
diagnostic results
, C) Only the patient's name and date of birth
D) Only the surgical procedure
Rationale: The correct answer is B) History and physical, advanced directives,
laboratory results, and diagnostic results. The surgical first assistant should
verify the operative consent and other pertinent information, including the history
and physical, advanced directives, laboratory results, and diagnostic results. The
assistant should also review the patient's medical chart and associated
documentation. This comprehensive review ensures patient safety and helps
anticipate the needs of the surgical team.
8. A surgical first assistant is preparing to insert a Foley urinary bladder
catheter. Which of the following is a key consideration for this procedure?
A) Use sterile technique only
B) Use sterile technique, verify catheter size, and inflate the balloon with the
correct volume of sterile water
C) Insert the catheter without any lubrication
D) Insert the catheter and inflate the balloon immediately
Rationale: The correct answer is B) Use sterile technique, verify catheter size,
and inflate the balloon with the correct volume of sterile water. When inserting
a Foley catheter, the surgical first assistant must use sterile technique, verify the
appropriate catheter size, and inflate the balloon with the correct volume of sterile
water. The catheter should be lubricated before insertion, and the balloon should
only be inflated after urine return is confirmed to verify placement in the bladder.
9. A patient is scheduled for surgery and has a history of diabetes. Which of
the following is a priority preoperative consideration for this patient?
A) Ensuring the patient has eaten a full meal
B) Monitoring and managing blood glucose levels
C) Administering a sedative
D) Placing the patient in the Trendelenburg position
Rationale: The correct answer is B) Monitoring and managing blood glucose
levels. For diabetic patients undergoing surgery, monitoring and managing blood
glucose levels is a priority to prevent hyperglycemia or hypoglycemia during the
