How to Pass the Surgical Tech Certification Exam in 2026: CST, TS-C and NRST

Last updated: October 2026

Let's skip the motivational preamble and get into what each exam tests and how to build a prep strategy that holds up under pressure.

Which surgical tech certification exam are you taking?

There are three national surgical technologist exams. Which one you can sit depends on where you trained. For help choosing, see our surgical tech certification guide.

Sources: NBSTSA, NBSTSA 2025 application, NCCT TS-C, NCCT test plan summary, NCCT scaled scores, My Next Move

What the CST exam covers

The Certified Surgical Technologist (CST) exam from the National Board of Surgical Technology and Surgical Assisting (NBSTSA) is the most widely recognized of the three and the one named in most state laws. It is a four-hour, computer-based exam with 175 multiple-choice questions, 150 of them scored. You pass by answering 98 of the 150 scored questions correctly (NBSTSA).

Two things stand out. Intraoperative procedures alone are 68 of the 150 scored items, so instrument knowledge, sterile technique and case flow should get most of your time. And the 25 unscored items are mixed in, so treat every question as if it counts. The NBSTSA publishes the exam outline and sells practice tests; use them to see how much weight each topic carries before you plan your weeks.

What the TS-C exam covers

The Tech in Surgery – Certified (TS-C) exam from the National Center for Competency Testing (NCCT) has 175 questions, 150 scored and 25 unscored pretest items, organized by the phases of a case (before, during and after surgery) rather than by subject (NCCT). You need a scaled score of 70, which is not the same as 70% correct (NCCT). The exam fee is $199 (NCCT). For the content breakdown, timing and the 125-case requirement, see our TS-C exam guide.

What the NRST exam covers

The Nationally Registered Surgical Technologist (NRST) exam from American Allied Health (AAH) is taken online: 150 multiple-choice questions in 2 hours (My Next Move). It covers three core areas:

• Perioperative care, including preoperative preparation, intraoperative procedures and postoperative responsibilities. Questions go deep into positioning complications, specimen handling protocols and surgical conscience, an ethical standard that's frequently tested in scenario-based questions.
• Anatomy and physiology. You'll see questions on surgical approaches to specific anatomical structures and physiological responses to anesthesia. Expect applied questions, not definitions.
• Surgical pharmacology and anesthesia. Hemostatic agents, anticoagulants, contrast media and the surgical tech's role in medication handling. This area trips up a lot of candidates who assumed pharmacology was "the nurse's job."

A passing score on the NRST exam is 70% or higher.

Our NRST certification guide covers eligibility, renewal and which employers accept it.

How hard is the CST exam? Pass rates by year

Hard enough that about three in ten first-time candidates don't pass. The NBSTSA reports these national first-attempt pass rates (NBSTSA):

The 2025 figure is from Pennsylvania College of Technology; NBSTSA had not posted it when we checked. Pass rates for individual programs vary widely, so ask any school you're considering for its own first-attempt rate. NCCT and AAH don't publish national pass rates that we could find.

What makes the exams hard isn't obscure facts. It's applying what you know to a scenario: what you do when a glove tears, when an instrument touches a non-sterile surface, or when a patient shows signs of malignant hyperthermia.

How to prioritize your study time without burning out

A common reason candidates fail is studying everything equally.

Start with a diagnostic. Before you commit to a timeline, take a full-length practice exam cold. Your weak areas will surface immediately, and you'll stop wasting hours reviewing what you already know. Our free surgical tech practice exam is a good starting point, and the 10 most common surgical tech exam questions show the style to expect.

From there, a timeline works best when it's weighted by your exam's outline. Here's a 16-week framework:

• Weeks 1 to 4: Perioperative care. Surgical positioning, draping, instrument identification and sterile field management. Build mental checklists; the exams use a lot of scenario questions here.
• Weeks 5 to 8: Anatomy and physiology. Use surgical approach maps alongside your anatomy review. Understanding why an incision is made in a specific location reinforces both areas at once.
• Weeks 9 to 12: Pharmacology and anesthesia. Memorize drug classifications, but spend equal time on clinical scenarios. How does a surgical tech respond when a patient shows signs of malignant hyperthermia? These questions come up more often than most prep books suggest.
• Weeks 13 to 16: Full review, timed practice exams and targeted drilling on the question types you miss.

Adjust the weeks to your exam. For the CST, perioperative care is about two-thirds of the scored questions, so it deserves more than four weeks, and pharmacology is only 6 items. For the TS-C, study by case phase (before, during and after surgery) rather than by subject. Use 30- or 45-minute blocks: an hour a day for several weeks beats five hours once a week.

Proven surgical tech exam prep strategies

Practice tests as diagnostic tools

The biggest mistake candidates make with practice tests is using them to feel good rather than to find gaps. Every wrong answer is a data point. Keep a running log of missed questions by content area; after three or four practice exams, a pattern will emerge. That pattern is your study priority list. Low-quality question banks recycle surface-level definitions. Good questions make you apply knowledge to realistic surgical scenarios.

Spaced repetition over marathon sessions

Spaced repetition has solid learning research behind it: information reviewed at increasing intervals is retained longer than content crammed in one sitting. For an exam that spans several content areas, long-term retention is the entire game. Apps like Anki work well for terminology and pharmacology. For procedural sequences and surgical technique, written scenario walkthroughs tend to stick better than passive reading.

Mix study methods to suit how you learn

Visual learners do well with diagrams, instrument charts and flowcharts of case steps. Auditory learners get more from educational videos and talking problems through in a group. Most people need both: flashcards and apps for instrument names, then practice questions that make you use them.

Study groups, with a catch

Study groups help on one condition: every session needs an agenda. Open-ended sessions tend to drift into reviewing what everyone already knows because it feels productive. Set a topic for each session, assign sections in advance, and quiz each other on scenario-based questions rather than definitions.

Connect theory to the operating room

Practical skills matter as much as theory. If you're in clinical rotations or already working, ask preceptors questions, watch cases in different specialties and ask to set up sterile trays. If you're not yet in a surgical setting, volunteering or part-time work in a hospital helps you picture the procedures the exam describes, and it strengthens your resume. See how surgical tech externships work.

Manage stress and use test-taking techniques

Sleep, regular exercise and slow breathing before and during the exam all help. On the day, read each question fully before looking at the answers, eliminate the options you know are wrong, and keep an eye on the clock. On the CST, four hours for 175 questions works out to about 80 seconds each. A review course or workshop can add test-taking tips and reinforce weak areas.

Find a mentor or study network

Online forums, study groups and professional associations such as the Association of Surgical Technologists (AST) offer study materials, workshops and encouragement. A mentor or instructor who knows your exam can spot your weak areas and point you to the right resources faster than you'd find them alone.

Common mistakes that derail prepared candidates

Capable students still fall into test-prep traps, like assuming clinical experience is enough or skimming study guides without building long-term retention. These are the ones that cost the most points.

1. Relying too much on memorization

The exams test how well you apply what you know to real clinical situations, not just what you know. You might memorize the steps for sterile gowning but not know what to do when a surgeon's glove tears. The same goes for pharmacology: knowing the name of a hemostatic agent is not the same as knowing when it's contraindicated, and the exams test the latter far more often. Pair memorization with scenario questions and case studies, and keep asking why a step is done that way.

2. Neglecting sterile technique scenarios

These show up across several content areas and are often framed as ethical decisions. What do you do when a team member breaks sterile field protocol and no one else acknowledges it? Know your answer cold.

3. Ignoring weak areas

Reviewing only familiar topics gives a false sense of security. You might be strong in anatomy but weak in microbiology, or strong in sterile processing but weak in pharmacology. Every outline covers all the core areas, so skipping one costs points. Take a diagnostic test early, spend extra time on weak topics, and use a rotation that mixes easy and hard subjects.

4. Not practicing under real exam conditions

Content-only preparation misses the format, pacing and pressure, which leads to rushed answers, second-guessing and fatigue. Set dates for full-length practice tests and treat them like the real thing: time yourself, remove distractions, don't pause or skip ahead, and review your results straight away. A long timed exam is a test of endurance, so practice taking full-length tests in one sitting.

5. Studying without a plan

Studying "whenever you have time" leads to cramming, missed content and stress, and many students underestimate how long preparation takes. A good plan has a topic-by-topic breakdown, weekly goals, scheduled practice exams, review days for weak areas and time for instruments and sterile procedures. A planner, a study app or a simple checklist keeps it on track.

6. Overlooking hands-on skills and instrument knowledge

The exams expect you to recognize clamps, retractors, scissors and forceps quickly and to apply sterile principles. Textbooks and online quizzes alone miss this. Review instrument sets, diagrams and lab videos, use simulation tools if your program has them, and drill instrument flashcards.

7. Skipping the candidate handbook

Each certifying body publishes official exam information: the NBSTSA's CST outline, NCCT's detailed test plan and AAH's candidate information. Most people don't read it. It contains the content breakdown, testing policies and sample question types. Reading it takes about 30 minutes and removes a lot of exam-day uncertainty.

Final exam-ready tips

• Start early. A slow, steady pace wins.
• Use several study tools: flashcards, textbooks, online quizzes and practice exams.
• Join a study group for support and discussion.
• Keep up with how surgery is changing, from robotic systems to new hemostatic agents.
• Look after yourself: sleep, manage stress and take breaks.
• Ask for help from instructors or mentors when you're stuck.
• Stay organized with a checklist or planner.

What happens if you fail? Retake rules

Failing once is common, and all three exams can be retaken. Knowing the rules up front is a good reason to treat your first sitting as your best shot.

• CST: you can reapply right away, paying the full fee each time, up to three attempts in a calendar year (NBSTSA 2025 application).
• TS-C: check NCCT's current retake policy before you book.

NRST: the exam fee includes one free retake, according to My Next Move.

Before you rebook, use your score report to find the content areas where you lost the most points and rebuild your plan around them.

Why a structured program changes the outcome

Self-study works for some candidates, but many do better with structure. The reason is accountability and sequencing: knowing what to study is only useful if you move through the material in the right order.

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Does your state require certification?

Most states don't license surgical technologists, but a few name a credential in law. Texas requires techs at licensed hospitals and surgery centers to complete an accredited program and hold the CST or TS-C, with some exceptions (see our Texas guide). Tennessee requires the CST or completion of a CAAHEP-accredited program (Midlands Technical College disclosure). Nevada requires an accredited program and the CST, with exceptions for military training, techs working before 2018 and staffing shortages (NRS 449.24185). None of these laws names the NRST.

Where there's no state rule, employers decide. Check the postings you plan to apply for before you choose which exam to take.

California: what you need to know

California operates under a voluntary certification model: no state law currently requires surgical tech certification (California guide). In practice, many California hospitals still ask for national certification, so check the postings where you want to work.

A 2014 bill that would have set state standards for surgical technologists, AB 2062, passed the Legislature but was vetoed by the governor (California Healthline). Texas, Tennessee and Nevada do have laws, and those name the CST (Texas also accepts the TS-C). Whether or not a state mandate arrives, certification is becoming the floor, not the differentiator.

Nationally, employment of surgical assistants and technologists is projected to grow 5% from 2025 to 2035 (BLS). In California, surgical technologists earned a median of $81,310 a year in May 2025, about $39 an hour, among the highest in the country (BLS; see surgical tech salary by state).

You're ready to pass

Passing the surgical tech certification exam comes down to three things:

• Knowing exactly what your exam (CST, TS-C or NRST) tests.
• Studying each content area in proportion to its weight.
• Building your prep around diagnostic data rather than comfort.

The candidates who pass on their first attempt are rarely the ones who studied the most hours. They're the ones who studied the right material, at the right depth, with enough structure to stay consistent across 12 to 16 weeks. Passing also opens the door to the career itself; see whether surgical tech is a good career for pay and outlook.

Frequently asked questions

How many questions are on the CST exam?

175 multiple-choice questions, of which 150 are scored. You have four hours.

What is the passing score for the CST exam?

You need 98 correct answers out of the 150 scored questions, according to the NBSTSA.

What is the CST exam pass rate?

The national first-attempt pass rate was 71.8% in 2024 and 69.1% in 2023, according to the NBSTSA. Penn College lists 68.6% for 2025.

How much does the CST exam cost?

$230 for AST members and $340 for non-members, according to the NBSTSA's 2025 application. The full fee is paid for each attempt.

How long should I study before taking the exam?

Plan several weeks of structured preparation. The plan above uses 16 weeks, weighted by the exam outline, so adjust it to your starting point and your exam.

Can I retake the surgical tech exam if I don't pass?

Yes. For the CST you can reapply immediately and pay the full fee again, up to three times a calendar year. Retake rules for the TS-C and NRST are set by NCCT and American Allied Health; check before you book.

What is the NRST exam and who administers it?

The Nationally Registered Surgical Technologist exam is a certification exam from American Allied Health, taken online: 150 multiple-choice questions in 2 hours. It covers perioperative care, anatomy and physiology, and surgical pharmacology.

What's the difference between the NRST and the CST?

The CST is awarded by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) and requires graduating from a CAAHEP- or ABHES-accredited program or military training. The NRST is awarded by American Allied Health and is open to graduates of eligible training programs, including online programs. The CST is the one named in state laws such as Tennessee and Nevada, so check what employers near you accept.

What is the TS-C exam?

The Tech in Surgery – Certified exam from the NCCT. It has 175 questions (150 scored), is organized by phases of surgery, needs a scaled score of 70 and costs $199. Graduates of NCCT-authorized programs also document 125 surgical cases.

Is surgical tech certification required in California?

No state law requires it: a 2014 bill (AB 2062) was vetoed. Many California hospitals and surgical facilities still ask for national certification, so check job postings first.

Are online surgical tech programs respected by employers?

Often, yes, as long as the program is structured, covers the exam content and prepares you for a recognized national certification that employers in your area accept. Check job postings first.

Where can I find CST practice questions?

The NBSTSA sells official practice exams. You can also try our free surgical tech practice exam and the 10 most common surgical tech exam questions.

Sources

• NBSTSA: Certified Surgical Technologist (CST)
• NBSTSA: 2025 CST exam application (fees)
• NBSTSA: CST exam pass rates
• NCCT: Tech in Surgery – Certified, TS-C (NCCT)
• NCCT: TS-C test plan summary
• NCCT: An explanation of scaled scores
• My Next Move: Nationally Registered Surgical Technologist (NRST), American Allied Health
• U.S. Bureau of Labor Statistics: Surgical Assistants and Technologists
• California Healthline: Brown vetoes bill to create standards for surgical technologists
• Nevada Revised Statutes 449.24185
• Midlands Technical College: Surgical Technology licensure disclosure
• Pennsylvania College of Technology: CST exam pass rate