The national first-time pass rate in 2024 was 71.8%, which means nearly one in three people walk out without their certification. That's because they didn't prepare strategically.
What Makes the Surgical Tech Exam Different from School Tests
The Certified Surgical Technologist (CST) exam isn't designed like your classroom tests. Your instructors might have focused heavily on specific procedures or specialty areas, but the National Board of Surgical Technology and Surgical Assisting (NBSTSA) doesn't care what your program emphasized.
The exam consists of 175 multiple-choice questions, 150 of which are scored, and those 25 unscored questions? They're scattered throughout to test future exam questions, so you won't know which ones count.
You've got four hours to prove you understand everything from pharmacology to positioning, from sterile technique to surgical procedures across multiple specialties. The exam tests whether you understand the reasoning behind every movement, every instrument choice, every protocol.
The Structure that Should be Top of Mind
Most practice materials give you random questions, but that's not how the exam works. The NBSTSA follows a specific content outline that breaks down like this:
- Perioperative care dominates with 91 questions.
- Additional duties cover 32 questions.
- Basic science rounds out with 27 questions.
What catches people off guard? The exam heavily weights situations you might handle once a month in real life but need to know cold for certification. It usually includes emergency protocols, rare complications, and specialty procedures.
"Having all graduates pass the National Certification Examination and earn their credentials through the NBSTSA is strong evidence of a curriculum's quality and a faculty's knowledge and dedication."
– Amy Broussard, Surgical Technology Program Director at SOWELA Technical Community College
Your Practice Exam Strategy
Forget cramming. The students who consistently pass treat practice exams as diagnostic tools, not confidence boosters.
- Start with baseline testing: Take a full-length practice exam within the first week of studying. The goal isn't to pass; it's to identify your knowledge gaps. Note which domains trip you up repeatedly.
- Study in content blocks: Your brain retains surgical information better when you focus on one domain at a time. Spend a week on perioperative care, another week on instrumentation, then circle back with mixed practice questions.
- Simulate exam conditions brutally: That means four hours straight, no phone, no music, same chair the whole time. Your bladder needs practice, too – the exam proctor won't pause your timer for bathroom breaks, and you can't return to previous questions after stepping away.
- Focus on your weak areas: It feels good to ace practice questions on topics you know well. It doesn't help you pass. Spend 70% of your study time on content areas where you're scoring below 75%.
The Exam Simulation Checklist
Use this checklist to ensure your practice exams mirror the testing experience:
- Question format: Use practice materials with multiple choice questions.
- Content distribution: Verify practice exams cover all three domains in correct proportions.
- Time pressure: Set a strict timer and stop when it expires.
- Score tracking: Record scores by domain to identify specific weaknesses.
- Review process: Spend twice as long reviewing wrong answers as you did taking the exam.
What Scoring High Requires
After analyzing what separates 98-scorers from 70-scorers, patterns emerge. Top performers reverse-engineer questions. Instead of reading the explanation for wrong answers, they ask: "What concept is this question testing?" Often, five different questions test the same underlying principle with different scenarios.
They build mental checklists for procedures. Rather than memorizing instruments for fifty different surgeries, they categorize by surgical approach and specialty, then note exceptions.
They practice educated guessing. On the exam, you'll encounter questions on topics you haven't seen since week three of school. Top scorers develop a systematic approach to eliminating obviously wrong answers, then choosing between remaining options based on surgical principles rather than memorized facts.
Surgical Tech Exam Realities
The surgical tech exam has ‘quirks’ that catch first-timers off guard. The difficulty doesn't progress linearly – you might encounter the hardest question at number seven and the easiest at number 142. Question length varies, with some requiring three sentences to ask what others ask in six words.
You need to correctly answer at least 98 questions to pass the CST examination out of the 150 scored questions. That's 65.3%. Sounds manageable until you remember you won't know which 25 questions are unscored.
The exam also tests critical thinking over memorization. You'll get scenarios asking what you'd do if your surgeon requests an instrument that would break sterile technique, or how you'd respond if you notice a count discrepancy. The right answer is what the NBSTSA guidelines say you should do.
Your Free Practice Exam Resource
Health Tech Academy offers a comprehensive surgical tech practice exam.
Our platform provides detailed explanations for every answer, which helps you understand the reasoning behind each choice.
The practice exams cover all three content areas in the exact proportions you'll see on test day, and the question difficulty calibrates to match testing standards. Unlike generic practice tests, these questions come from surgical technology educators who understand what trips up test-takers.
Enroll and access Health Tech Academy's free Surgical Tech practice exam.
Meet Your Surgical Tech Educator
Hear from One of Our Students
The Week Before Your Exam
- Stop taking full-length practice exams three days before test day. Your score won't improve significantly in 72 hours, but your anxiety can increase. Instead, do short content reviews of your weakest areas – 20-minute sessions focusing on specific topics.
- Verify your testing location and arrival time. Sounds basic, but every testing cycle has candidates who show up at the wrong PSI testing center or arrive after check-in closes.
- Prepare your identification the night before. You need a government-issued ID that matches your registration. Some testing centers reject passports if your application used a driver's license.
After Your First Practice Exam Score
Your initial practice exam reveals your starting point. Students who score 60% on their first practice exam often pass the real thing after strategic preparation. Students who score 85% on early practice tests sometimes fail if they don't identify and address specific knowledge gaps.
Use this formula to gauge your readiness: you should be scoring at least 80% on full-length practice exams consistently (meaning three in a row) before scheduling your exam.
The surgical tech exam tests whether you're ready to be trusted in an operating room. Practice exams test whether you're ready for the exam. Different goals, different preparation strategies. Treat practice exams as learning tools that expose weaknesses, not progress reports that measure how smart you are.
- Start with authentic practice materials.
- Simulate testing conditions.
- Address knowledge gaps systematically.
Frequently Asked Questions and Answers
How Many Times can I Take the Surgical Tech Exam if I Don't Pass?
You can attempt the exam multiple times, but there are restrictions on timing between attempts. After failing, you must wait before retaking, and the waiting period may increase with each subsequent failure.
How Long Should I Study Before Taking a Practice Exam?
Start with a diagnostic practice exam immediately. This baseline identifies your weak areas so you can study efficiently rather than reviewing content you already know.
What if I'm Scoring Well on Practice Exams but Still Feel Unprepared?
If you're consistently scoring 80% or higher on full-length practice exams under timed conditions, you're likely ready. Test nerves are normal, but don't let that delay your exam indefinitely.
What Should I Focus on Studying the Night Before My Surgical Tech Exam?
The night before your exam, stick to light review rather than intensive studying. Go over topics like sterile technique principles, basic instrumentation, and surgical case flow. Organize your materials, plan your test-day logistics, and get adequate rest to ensure you’re alert and focused on exam day.
