- The exam is 150 four-choice questions in three hours, with one optional 15-minute break and a 70% passing score.
- Domains 1 through 4 each carry 22%; Pre- and Postoperative Considerations carries only 12%.
- Eligibility requires 120 documented intraoperative first-assisting hours in the preceding two years; classroom and seminar hours do not count.
- Initial exam costs USD 425, retakes cost USD 195, and you get a maximum of three attempts in 12 months.
What This Credential Is (and Is Not)
RNAS-C, as covered on this page, stands for Registered Nurse Assistant at Surgery - Certified. It is a surgical first-assisting certification administered by the National Assistant at Surgery Certification (NASC), and the examination is delivered through Prolydian live remote proctoring. It is built for registered nurses who already work as first assistants in the operating room and want a formal credential that documents that role.
It is not NCLEX-RN, and it is not a path to initial RN licensure. Everything on the exam assumes you already hold an unrestricted RN license and already function in the intraoperative environment. If you need a primer on the name itself, see What Does RNAS-C Stand For? or the broader overview in What Is RNAS-C Certification?.
Exam Snapshot: Format, Fees, Scoring
Here is the one-glance version of the testing mechanics. Every figure below comes from the certifying body's published materials, which were last checked on October 15, 2026.
| Item | Detail |
|---|---|
| Certifying body | National Assistant at Surgery Certification (NASC) |
| Delivery | Prolydian live remote-proctored examination |
| Question count | 150 multiple-choice questions |
| Answer format | Four choices, one correct answer |
| Time allowed | Three hours |
| Break | One optional 15-minute break |
| Passing score | 70% |
| Initial exam fee | USD 425 |
| Retake fee | USD 195 |
| Results | Within 72 hours |
| Certification term | Three years |
Two details deserve emphasis. First, the 70% figure is a passing score, not a pass-rate statistic; it tells you the threshold you must reach, not how many candidates succeed. For a deeper look at how the threshold works, read RNAS-C Passing Score 2026, and for the data question see RNAS-C Pass Rate 2026: What the Data Shows. Second, the published materials do not establish any extension of the examination allowance, so plan around the standard three hours.
For the full pricing picture beyond the exam fee itself, including recertification costs, see RNAS-C Certification Cost 2026.
Eligibility Checklist
Eligibility is where most candidates get stuck, because the hour documentation takes time to assemble. Work through this list before you pay for anything.
- Current unrestricted RN license in the country where you practice.
- Current ACLS, BLS, or CPR certification.
- Acceptable formal RNFA-program completion.
- 120 documented intraoperative first-assisting hours within the preceding two years.
- Current CNOR if you are a non-APRN applicant; APRNs instead use accredited APRN certification.
- Recommendations from both a surgeon and an operating-room supervisor or manager (required on both routes).
A bachelor's degree is not required. The window matters too: the 120 hours must fall within the preceding two years, so older experience does not rescue a thin recent record. The complete walkthrough lives in RNAS-C Requirements 2026: Eligibility, Prerequisites & How to Qualify.
The Five Content Sections and Their Weights
The exam is organized into five weighted content sections drawn from the current issuer-linked RNAS-C Exam Study Guide, which is undated. These are examination content headings, not an editorial curriculum, and the study guide verifies each heading and its weight. The first four sections tie for the largest allocation.
| Domain | Weight |
|---|---|
| Domain 1: Surgical Patient Care | 22% |
| Domain 2: Surgical Skill | 22% |
| Domain 3: Anatomy & Physiology | 22% |
| Domain 4: Procedure Considerations | 22% |
| Domain 5: Pre- and Postoperative Considerations | 12% |
Domains 1 and 2: Surgical Patient Care and Surgical Skill (22% each)
These two sections cover the hands-on core of the first-assistant role: caring for the patient across the surgical encounter and performing the technical work at the table. Candidates should expect scenario-style items that ask what a first assistant should do or anticipate.
- Think in terms of the first assistant's responsibilities at the operative field.
- Domain 2 uses the formal PDF wording "Surgical Skill" (the current HTML page writes "Surgical Skills").
Domain 3: Anatomy & Physiology (22%)
Applied anatomy and physiology as it relates to surgical exposure, structures at risk, and physiologic response. This is the section that rewards deep, procedure-linked knowledge over memorized lists.
- Study anatomy in the context of the incisions and approaches you actually assist with.
Domain 4: Procedure Considerations (22%)
Procedure-specific knowledge: what a given operation involves and what the first assistant must be prepared for. Your daily case mix helps here, but the exam is not limited to the procedures you personally see.
- Stretch beyond your own specialty so unfamiliar procedures do not surprise you.
Domain 5: Pre- and Postoperative Considerations (12%)
The smallest section by weight, covering the periods before and after the operation. Smaller does not mean skippable: 12% of 150 questions is still a meaningful block of items.
- The study guide verifies this heading and weight but supplies no detailed Section V objective list, so no further subtopics are listed here.
For a full breakdown of each area, see RNAS-C Exam Domains 2026: Complete Guide to All 5 Content Areas.
Scheduling, Results, and Retake Rules
The scheduling rules are strict enough that a missed detail can cost you money, so memorize these.
- Testing window: test within four months of application.
- Rescheduling: reschedule at least four hours before the appointment.
- Results: delivered within 72 hours.
- First retake: allowed 45 to 90 days after the original examination.
- Attempt cap: maximum of three attempts in 12 months.
Key Takeaway
The 45-day minimum wait before a retake means a failed attempt costs you at least a month and a half plus the USD 195 fee. Treat your first attempt as the real one and book it only when your practice scores are stable. See RNAS-C Exam Dates 2026 for scheduling detail.
Recertification Cheat Sheet
Certification lasts three years. The recertification requirements were updated on August 6, 2025, so older third-party summaries may be out of date. Here is the current structure.
- Maintain your RN licensure and BLS.
- Document 300 RNFA practice hours, including 250 intraoperative hours.
- Then choose one of two routes:
- Points route: earn 240 points; the fee is USD 275.
- Exam route: pass the recertification examination; the fee is USD 325.
Legacy application note: the issuer's FAQ says the legacy online application remains available through the remainder of 2026 for applicants who already started recertification. The new application is downloadable. If you began under the old process, contact NASC about your transition rather than assuming you can freely pick whichever rule set you prefer.
Turning the Weights Into a Study Plan
Because four sections carry 22% each and the fifth carries 12%, an even split across the first four with a lighter pass on Domain 5 matches the exam's actual shape. Here is one way to sequence an eight-week run, with the reasoning attached to each block. For a fuller method, see RNAS-C Study Guide 2026: How to Pass on Your First Attempt.
Anatomy & Physiology first
- It is a 22% section and underpins both procedure and skill questions.
- Tie every structure to the approach and exposure you would assist with.
Procedure Considerations
- Build on the anatomy work while it is fresh.
- Deliberately cover procedures outside your usual case mix.
Surgical Skill and Surgical Patient Care
- Review the first-assistant responsibilities at the field and across the patient's surgical course.
- Practice scenario items that ask for the best next action.
Pre- and Postoperative Considerations
- A lighter 12% section, but enough items to matter; give it a focused pass.
Timed full-length practice
- Simulate 150 questions in three hours, including a decision about whether you will take the optional 15-minute break.
Use the RNAS-C practice test platform to run timed sets so the three-hour pace feels routine before test day, and track which domains drag your score below the 70% line.
Common Mix-Ups to Avoid
Confusing the passing score with the pass rate
Seventy percent is the score you need on your exam. It says nothing about what share of candidates pass. If you want context on difficulty, read How Hard Is the RNAS-C Exam? rather than inferring it from the passing score.
Counting the wrong hours
Only documented intraoperative first-assisting hours, including eligible internship or practicum hours, count toward the 120. Classroom and seminar time does not. The same logic applies at recertification, where the 250 intraoperative hours sit inside the 300 practice-hour requirement.
Treating Domain 5 as optional
Weighted at 12%, it is the smallest section, but ignoring it gives away a real slice of the 150 questions.
Importing facts from other credentials
The RNAS-C acronym is shared by other credentials elsewhere in healthcare. Fees, dates, and requirements here apply only to the NASC credential described above. If you are weighing whether it fits your career, Is the RNAS-C Certification Worth It? and RNAS-C Jobs cover the career side.
Key Takeaway
Before you register, verify the current details against the certifying body's own pages (the candidate handbook, the About the RNAS-C Exam page, and the recertification page). Requirements were updated as recently as August 2025, so confirm fees and rules directly with NASC.
Frequently Asked Questions
The exam has 150 four-choice, single-answer questions and a three-hour limit, with one optional 15-minute break. The published materials do not establish any extension of the examination allowance.
The passing score is 70%. That is a score threshold, not a pass-rate statistic, so it does not tell you how many candidates pass.
Four domains tie at 22% each: Surgical Patient Care, Surgical Skill, Anatomy & Physiology, and Procedure Considerations. Pre- and Postoperative Considerations is the smallest at 12%.
You can retake the exam for USD 195, with the first retake allowed 45 to 90 days after the original exam. You are limited to a maximum of three attempts in 12 months.
Maintain RN licensure and BLS, document 300 RNFA practice hours including 250 intraoperative hours, and then either earn 240 points (USD 275 fee) or pass the recertification exam (USD 325 fee). The 300 practice hours contribute 30 of the 240 points, and one CE/CME hour earns two points.
For the broader picture of what this credential covers and where it can lead, start with RNAS-C Certification, and check earning context in the RNAS-C Salary Guide. When you are ready to test your recall under realistic timing, head to the main practice test site.