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NBSTSA CSFA Prep Online

Certified Surgical First Assistant

Pass the NBSTSA CSFA the first time with expert-designed practice questions, detailed rationales, engaging videos, realistic practice exams, and a proven track record of student success

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I. Perioperative Care490 questions
II. Ancillary Duties125 questions
III. Advanced Science272 questions

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Results

Date: 19th Aug 2026Time Taken: 00:00:31

I. Perioperative Care

Answers Result

During a laparoscopic cholecystectomy, the surgeon encounters significant bleeding from a branch of the cystic artery. As a Certified Surgical First Assistant, what immediate action should you take to assist the surgeon in controlling the bleeding?

Incorrect

A.Increase the pneumoperitoneum pressure to tamponade the bleeding
B.Switch from laparoscopic to open surgery immediately
C.Apply direct pressure with a laparoscopic gauze while preparing a hemostatic clip
D.Request the surgical team to lower the table for better visualization

During a laparoscopic procedure, the team is using a monopolar electrocautery device. Which action should the surgical assistant prioritize to reduce the risk of unintended intra-abdominal thermal injury (e.g., from insulation failure or stray energy transfer)?

Correct

A.Inspect the instrument insulation and ensure the active electrode is activated only when the tip is in direct view and in contact with the intended target tissue.
B.Increase the power setting to shorten activation time and reduce heat spread.
C.Keep the electrode activated continuously while moving between target sites to maintain efficiency.
D.Place the return electrode (grounding pad) on a flat, well-perfused muscle area to prevent burns.

During a minimally invasive radial artery harvest for coronary artery bypass grafting (CABG), the first assistant notes that several side branches are very small and fragile. Which strategy best preserves the radial artery and minimizes complications during branch control?

Incorrect

A.Use high-frequency electrocautery to cauterize branches quickly
B.Divide all branches sharply with scissors as the primary method of control
C.Individually ligate the fragile branches using clips or ties, or a low-thermal vessel-sealing device, and then divide them
D.Place the artery under significant traction to improve exposure before taking branches

Answers Result

Incorrect

A.Increase the pneumoperitoneum pressure to tamponade the bleeding
B.Switch from laparoscopic to open surgery immediately
C.Apply direct pressure with a laparoscopic gauze while preparing a hemostatic clip
D.Request the surgical team to lower the table for better visualization

Applying direct pressure with a laparoscopic gauze while preparing a hemostatic clip is the correct action because it allows for immediate control of the bleeding while the necessary equipment is prepared to achieve hemostasis. The cystic artery is a common site for bleeding during cholecystectomy procedures, and using direct pressure in combination with hemostatic techniques is standard practice in laparoscopic surgery. Increasing the pneumoperitoneum pressure might temporarily reduce bleeding by compressing vessels, but it can also obscure the surgical field and does not address the source of bleeding effectively. Requesting the surgical team to lower the table for better visualization does not address the immediate need to control bleeding and may delay effective intervention. Switching from laparoscopic to open surgery immediately might be a consideration if bleeding cannot be controlled laparoscopically, but this is not the first line of action and involves significantly more risk and time.

Correct

A.Inspect the instrument insulation and ensure the active electrode is activated only when the tip is in direct view and in contact with the intended target tissue.
B.Increase the power setting to shorten activation time and reduce heat spread.
C.Keep the electrode activated continuously while moving between target sites to maintain efficiency.
D.Place the return electrode (grounding pad) on a flat, well-perfused muscle area to prevent burns.

Unintended laparoscopic thermal injury with monopolar cautery is commonly associated with factors such as insulation failure and stray energy transfer when the electrode is activated out of view or near other instruments/trocars. Prioritizing inspection of insulation and activating only when the electrode tip is directly visualized and applied to the intended tissue reduces the chance of inadvertent burns. Using higher power and prolonged/continuous activation increases the risk of collateral thermal damage. The choice describing return-electrode placement helps reduce return-electrode burns at the skin site, but it does not address the most common mechanisms of intra-abdominal unintended injury during laparoscopy.

Incorrect

A.Use high-frequency electrocautery to cauterize branches quickly
B.Divide all branches sharply with scissors as the primary method of control
C.Individually ligate the fragile branches using clips or ties, or a low-thermal vessel-sealing device, and then divide them
D.Place the artery under significant traction to improve exposure before taking branches

Individually ligating fragile branches with clips or ties (or using a low-thermal vessel-sealing device) and then dividing them provides reliable hemostasis while minimizing thermal spread and traction injury, helping preserve conduit integrity for grafting. The choice mentioning high-frequency electrocautery increases the risk of thermal injury to the arterial wall. The choice describing sharp division with scissors as the primary method of control risks bleeding and inadvertent vessel injury if branches are not secured. The choice about significant traction can avulse delicate branches or cause intimal damage.

Understand why,
not only what.

NBSTSA CSFA questions test how you apply knowledge in real situations. After every answer, you are provided with a clear rationale so you can understand the reasoning, learn from mistakes, and recognize it when it appears again.

Question 1 of 3

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What students say about Prepia for the NBSTSA CSFA

“I used the app daily while studying for the NBSTSA FA exam. I loved that it was broken down into the 3 areas that the test is based on, perioperative care, ancillary duties, and advanced science. I would do the daily questions and allowed for the app to remind me. I believe that this was helpful in allowing me to pass my certification test the first time.”

H@yles82· App Store

NBSTSA CSFAPassed first time

“This app is great! It really helped me prepare for the csfa exam. I would definitely recommend it.”

Molly HallNBSTSA CSFA

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NBSTSA CSFA Prep Online

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Every subject area, covered

Understand why,not only what.

Study anywhere, on any device

Pick up on the web

Take it in your pocket

Every answer shapes what you study next.

Practice

Understand

Focus

Improve

What students say about Prepia for the NBSTSA CSFA

Before you start,you probably want to know…

Are the questions on practice exams like the ones on the real NBSTSA CSFA?

How is this different from a prep book?

How long do I need to prepare?

Can I study on my phone?

What happens if I don't pass?

Understand why,
not only what.

Before you start,
you probably want to know…