If you've made it to the point of studying for your surgical tech certification exam, you already know the stakes. This is not a test you wing. The National Registered Surgical Technologist (NRST) exam, administered by the American Allied Health (AAH), is a 100-question multiple-choice assessment that determines whether you're cleared to work in sterile fields, assist in live surgeries, and handle instrumentation that directly affects patient outcomes. California doesn't mandate statewide licensure for surgical techs, but hospitals require national certification – and many won't interview without it.