- The Number: 70% of 150 Questions
- What the Passing Score Does and Does Not Tell You
- Exam Format and Testing Mechanics
- How the Five Weighted Sections Shape Your Score
- If You Miss the Mark: Retake Rules and Costs
- Eligibility Comes Before the Score
- Setting a Practice Score Target
- A Short Preparation Sequence Built Around the Weights
- After You Pass: Three-Year Certification
- Frequently Asked Questions
- The RNAS-C passing score is 70% on a 150-question multiple-choice exam, so you need roughly 105 correct answers.
- The first four content sections each carry 22%; Pre- and Postoperative Considerations carries 12%.
- You have three hours, with one optional 15-minute break, and no established extension of the examination allowance.
- The first exam costs USD 425; a retake costs USD 195, available 45-90 days after the original attempt.
The Number: 70% of 150 Questions
The Registered Nurse Assistant at Surgery - Certified (RNAS-C) credential, awarded through the National Assistant at Surgery Certification (NASC), uses a straightforward passing standard: 70%. The exam contains 150 multiple-choice questions, each with four answer choices and exactly one correct answer. A 70% result on 150 questions works out to 105 correct responses. Put differently, you can miss up to 45 questions and still land on the passing line, assuming every question is scored the same way.
That arithmetic is a useful planning anchor, but treat it as a working estimate rather than a promise. NASC publishes the 70% threshold; it does not publish a question-by-question scoring breakdown in the materials we reviewed, so we do not claim to know whether any items are unscored or how individual questions are weighted beyond the five content sections. If your preparation plan depends on landing at exactly 105, you have left yourself no margin. Aim above the line.
What the Passing Score Does and Does Not Tell You
It is a fixed threshold
NASC states the passing score as a percentage, 70%, rather than describing a curve or a rank-based cutoff. For a candidate, that is good news: your result depends on your own performance against a stated standard, not on how the other people testing that day happened to do.
It does not replace content mastery
Because the exam is a surgical first-assisting certification, the questions test the knowledge of someone who works at the operative field. This is a different assessment from NCLEX-RN or initial RN licensure, and a strong general nursing background will not automatically carry you to 70%. Candidates who first-assist regularly often find the anatomy and procedure-specific material is where the real gaps appear. For a realistic view of the challenge, read How Hard Is the RNAS-C Exam? Complete Difficulty Guide 2026.
It is not a per-section requirement we can verify
The published materials give a weight for each content section and a single overall passing score of 70%. We have not found a statement that you must reach 70% in every individual section, and we will not invent one. Plan on the overall score being what counts, but avoid the temptation to neglect a section entirely, because every section contributes questions to your total.
Exam Format and Testing Mechanics
Understanding the delivery format helps you convert knowledge into points. Here is how the RNAS-C examination works:
| Feature | Detail |
|---|---|
| Certifying body | National Assistant at Surgery Certification (NASC) |
| Delivery | Prolydian live remote-proctored examination |
| Questions | 150 multiple-choice, four choices, one correct answer |
| Time allowed | Three hours |
| Break | One optional 15-minute break |
| Passing score | 70% |
| Results | Within 72 hours |
| Initial exam fee | USD 425 |
| Retake fee | USD 195 |
Pacing across three hours
With 150 questions in three hours, you have an average of about 72 seconds per question before accounting for the break. That pace is comfortable for recall-style items (identifying a structure, naming an instrument, recognizing a step) and tighter for scenario items that ask you to reason through patient care or procedure decisions. A sensible approach is to move quickly through questions you know cold so you bank time for the slower ones.
The break and the clock
The exam allows one optional 15-minute break. There is no established extension of the examination allowance, so do not plan on extra time. Decide before test day whether you will use the break, and practice sitting through long mock sessions so you know how your focus holds up around the two-hour mark.
Remote proctoring logistics
Because the exam is live and remote-proctored through Prolydian, your testing environment is part of your preparation. Confirm your equipment and room setup well ahead of time. You must also schedule within four months of your application, and you can reschedule as long as you do so at least four hours before your appointment. For scheduling details, see RNAS-C Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
How the Five Weighted Sections Shape Your Score
The exam's content is organized into five weighted sections taken from the issuer-linked RNAS-C Exam Study Guide. The guide is undated, and its March 2023 hosting location should not be read as a statement about the exam's version year. Notably, the guide verifies the fifth section's heading and weight but does not provide a detailed objective list for it, so we do not guess at its subtopics.
Four sections tie for the largest allocation at 22% each; the fifth is 12%. On a 150-question exam, that distribution suggests roughly 33 questions per large section and about 18 for the smallest, though actual item counts on any given form may vary. Treat these as proportional guides, not guarantees.
Domain 1: Surgical Patient Care (22%)
This section addresses the care of the patient across the surgical experience from the first assistant's perspective. Expect scenario-style questions that test judgment, safety awareness, and patient-centered decisions.
- Read each stem for the patient-safety angle before looking at the options.
- Anchor your answers in the first-assistant role rather than the circulating or scrub role.
Domain 2: Surgical Skill (22%)
The study guide PDF uses the heading "Surgical Skill" (the current HTML page says "Surgical Skills"); we preserve the formal PDF wording here. This section covers the hands-on competencies of first assisting at the operative field.
- Review technique-focused topics you perform, then verify them against reference texts.
- Do not assume local habit equals the best-supported answer on a standardized exam.
Domain 3: Anatomy & Physiology (22%)
Because first assistants work directly in the surgical field, anatomical relationships carry heavy weight. Knowing structures and how they relate is a major scoring lever.
- Study regionally: what lies adjacent to what, and what is at risk during exposure.
- Pair anatomy with the procedures in which it matters, not in isolation.
Domain 4: Procedure Considerations (22%)
This section ties procedural knowledge to the assistant's role: what a given operation involves and what the first assistant should anticipate.
- Walk through procedures step by step in your head, noting your role at each stage.
- Connect each procedure back to the anatomy it exposes.
Domain 5: Pre- and Postoperative Considerations (12%)
The smallest section by weight, but not one to skip. Twelve percent of a 150-question exam still represents a meaningful block of points.
- Because no detailed objective list is published for this section in the guide we reviewed, rely on the heading itself and your clinical experience of the perioperative arc.
For a deeper walkthrough of each content area, see RNAS-C Exam Domains 2026: Complete Guide to All 5 Content Areas.
Key Takeaway
Four sections at 22% means 88% of the exam sits in Surgical Patient Care, Surgical Skill, Anatomy & Physiology, and Procedure Considerations. A weak spot in any one of those four costs you far more than a weak spot in Pre- and Postoperative Considerations.
If You Miss the Mark: Retake Rules and Costs
A score under 70% is not the end of the road, but the retake system has firm rules worth knowing before your first attempt.
- Waiting period: Your first retake becomes available 45-90 days after your original examination.
- Attempt limit: You may test a maximum of three times in a 12-month period.
- Retake fee: USD 195 per retake, compared with USD 425 for the initial examination.
The 45-day minimum wait is the detail that most affects planning. It means a failed attempt costs you at least six weeks, so use your first sitting as a genuine attempt rather than a trial run. Complete pricing context, including recertification fees, is in RNAS-C Certification Cost 2026: Complete Pricing Breakdown.
Turning a near-miss into a retake plan
If you fall short, resist the urge to restudy everything evenly. Use the 45-90 day window to rebuild the sections where you felt least certain, giving priority to the 22% sections. Because the waiting period leaves time for focused work, a targeted plan almost always beats a repeat of your original approach.
Eligibility Comes Before the Score
You cannot sit for the exam, and therefore cannot earn a passing score, until you meet NASC's candidate requirements. These are worth reviewing early because assembling documentation can take longer than studying.
- A current, unrestricted RN license in the country of practice.
- Current ACLS, BLS, or CPR certification.
- Acceptable formal RNFA-program completion.
- 120 documented intraoperative first-assisting hours in the preceding two years. Eligible internship or practicum hours count; classroom and seminar hours do not.
- For non-APRN applicants, a current CNOR; APRNs use accredited APRN certification.
- Recommendations from both a surgeon and an operating-room supervisor or manager.
A bachelor's degree is not required. The full list, with nuances, appears in RNAS-C Requirements 2026: Eligibility, Prerequisites & How to Qualify. If you are still deciding whether the investment makes sense, Is the RNAS-C Certification Worth It? Complete ROI Analysis 2026 lays out the tradeoffs.
Setting a Practice Score Target
Because the passing line is 70%, a sensible practice goal sits comfortably above it. Scoring right at 70% on practice material leaves little room for the stress of a proctored, timed sitting. We do not have published data on how practice scores translate to exam outcomes, so use the following as a conservative planning heuristic rather than a guarantee: build a buffer so that a bad hour on test day does not sink you.
- Track your practice results by section, not just overall, so you can see whether you are leaning on one strong area to mask a weak one.
- Pay special attention to performance on the four 22% sections, since they make up the bulk of the exam.
- Treat any section where you consistently feel unsure as a priority, even if your overall number looks acceptable.
You can build this habit with timed sets on our RNAS-C practice test site, which lets you rehearse the question style and pacing before the real thing.
A Short Preparation Sequence Built Around the Weights
Rather than a generic schedule, sequence your preparation by how much each section is worth and how the topics build on one another. Anatomy underpins procedures, so it comes first.
Anatomy & Physiology (22%)
- Build regional anatomy knowledge, since later sections depend on it.
- Note relationships and structures at risk during exposure.
Procedure Considerations and Surgical Skill (22% each)
- Walk through procedures with your first-assistant role in focus.
- Tie every technique back to the anatomy you reviewed.
Surgical Patient Care and Pre- and Postoperative Considerations (22% and 12%)
- Practice scenario questions with a patient-safety lens.
- Cover the perioperative arc, using the section heading as your guide.
Full-length timed practice
- Simulate 150 questions in three hours, including your planned break decision.
- Review misses by section and patch the weakest area.
For a broader plan with resources and a first-attempt strategy, see RNAS-C Study Guide 2026: How to Pass on Your First Attempt, and keep the RNAS-C Cheat Sheet 2026: One-Page Review of Must-Know Facts handy for last-minute review of format facts.
After You Pass: Three-Year Certification
Earning the credential gives you a three-year certification period. To maintain it, NASC updated its recertification requirements on August 6, 2025. You will need to keep your RN licensure and BLS current, document 300 RNFA practice hours (including 250 intraoperative hours), and then choose one of two paths: earn 240 points and pay a USD 275 fee, or pass the recertification examination for USD 325.
Be careful with the points path. The 300 required practice hours contribute 30 of the 240 points, and one CE/CME hour earns two points, so points are not interchangeable with CE hours. NASC's FAQ also notes that the legacy online application remains available through the remainder of 2026 for applicants who already started recertification; those applicants should contact NASC about the transition rather than assume they can freely pick between old and new rules.
If you are weighing the career side of certification, see RNAS-C Salary Guide 2026: Complete Earnings Analysis and RNAS-C Jobs for where the credential fits in the workplace.
Frequently Asked Questions
The passing score is 70%. On the 150-question exam, that corresponds to roughly 105 correct answers, though you should aim well above that line to leave a margin for test-day variability.
No. The passing score is the percentage you must earn on the exam. A pass rate describes the share of candidates who succeed, which is a separate statistic. See our dedicated article on the RNAS-C pass rate for that distinction.
You have three hours for 150 multiple-choice questions, with one optional 15-minute break. There is no established extension of the examination allowance, so plan your pacing accordingly.
Your first retake is available 45-90 days after the original examination and costs USD 195. You may attempt the exam a maximum of three times in a 12-month period.
Results are provided within 72 hours of completing the examination, which is delivered as a live, remote-proctored test through Prolydian.
Your passing score is straightforward to state: 70% on 150 questions, three hours, one shot at a time with defined retake rules. The harder work is building real command of the four 22% sections and respecting the 12% section enough that it never becomes a liability. Rehearse the format, plan your retake contingency before you need it, and use timed practice at the RNAS-C Exam Prep practice test site to walk into the proctored session with a cushion above the line.