If you are finishing a respiratory therapy program, you have probably heard that the National Board for Respiratory Care (NBRC) is changing its credentialing exams. That news can feel unsettling when you are already juggling clinicals and coursework. The good news is that the new exam is built on the same core skills you have been practicing, and once you understand the blueprint, you can study with a clear plan.

Starting January 4, 2027, the new Respiratory Therapy (RT) Examination replaces the Therapist Multiple-Choice (TMC) Examination and the separate Clinical Simulation Examination (CSE) as the route to the Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT) credentials.

In this guide, we’ll walk you through the transition timeline, the exam format, every section of the new content outline, and the questions candidates ask most.

What Is the NBRC RT Examination?

The NBRC is the national credentialing body for respiratory therapists in the United States. Employers and state licensing boards use its CRT and RRT credentials to confirm that a therapist has the knowledge and judgment needed for safe practice.

Until now, most candidates took the TMC first. Passing at the low cut score earned the CRT, and passing at the high cut score made you eligible for the CSE, a branching patient-simulation exam required for the RRT. The RT Examination combines those steps into one sitting. A single total score is compared with two cut scores:

  • Below the low cut score: You do not earn a credential and may retest.
  • At or above the low cut score: You earn the CRT credential.
  • At or above the high cut score: You earn the RRT credential.

Because your score decides which credential you earn, it makes sense to prepare for the RRT standard from day one.

What Is the Transition Timeline From TMC and CSE?

The NBRC has published firm dates for the changeover:

  • December 31, 2026: Last day to take the TMC. The CRT-to-Registry admission policy also ends on this date.
  • January 4, 2027: The RT Examination launches, based on the RT Detailed Content Outline effective January 2027.
  • December 31, 2027: Last day to take the CSE. Only candidates who passed the TMC at the high cut score by December 31, 2026, can take it. Those candidates may also choose to take the RT Examination and pass at the high cut score instead.

If you are testing in the final months of 2026, you are still preparing for the TMC (and possibly the CSE), which follow the January 2020 TMC and CSE Detailed Content Outlines. Everyone else should study from the new RT outline described below.

What Is the NBRC RT Exam Format?

Here are the essentials from the RT Examination Detailed Content Outline and the NBRC Candidate Handbook (September 2026):

  • Questions: 185 multiple-choice items.
  • Scored vs. pretest: 160 scored items and 25 unscored pretest items. Pretest items are not identified, so treat every question as if it counts.
  • Time: 4 hours.
  • Two portions: Breadth of Knowledge (100 scored items) and Depth of Clinical Judgment (60 scored items).
  • Delivery: Computer-based testing through PSI at nearly 300 assessment centers.
  • Scoring: Your total score is compared with a low cut score (CRT) and a high cut score (RRT). The NBRC does not publish a fixed percentage needed to pass.
  • Results: PSI emails your score report after the exam; contact PSI if you don’t receive it within 24 hours.
  • Fees: $360 for new applicants and $300 for repeat applicants.

What Is Covered in the Breadth of Knowledge Portion?

The Breadth of Knowledge portion covers the tasks respiratory therapists perform every shift. Of its 100 items, only 23 are recall; the other 77 ask you to apply or analyze information. Knowing a definition is rarely enough.

Patient Data (25 Items)

This domain tests whether you can find, collect, and interpret the information that drives care. It includes 6 recall, 15 application, and 4 analysis items.

  • Evaluate data in the patient record (3): History, lab results, imaging, pulmonary function results, sleep studies, and monitoring trends.
  • Perform clinical assessment (6): Inspection, interview, palpation, auscultation, and chest radiograph review.
  • Perform procedures to gather information (5): Blood gas analysis, ECGs, spirometry, lung volumes, DLCO, spontaneous breathing trials, and cuff management.
  • Evaluate procedure results (7): Interpreting ABGs, hemodynamics, compliance, auto-PEEP, and pulmonary function results.
  • Recommend diagnostic procedures (4): Choosing tests such as bronchoscopy, thoracentesis, sleep studies, or exhaled gas analysis.

Study tip: Practice full ABG interpretation until it is automatic (normal pH 7.35–7.45, PaCO2 35–45 mm Hg, HCO3 22–26 mEq/L), then add compensation and oxygenation.

Management of Devices and Patient Safety Procedures (25 Items)

This domain focuses on equipment: setting it up, making sure it works, and fixing it when it doesn’t. It includes 8 recall, 12 application, and 5 analysis items.

  • Troubleshoot devices during and after assembly (19): Oxygen delivery devices, heated high-flow, CPAP/NPPV, nebulizers and inhalers, ventilators, artificial airways, chest drainage systems, and hemodynamic monitors.
  • Infection prevention, safety, and quality assurance (6): Standard Precautions, disinfection, biohazard handling, quality control, and ventilator-associated event protocols.

What questions look like: A low-pressure alarm with a falling exhaled volume, a chest drainage system with continuous bubbling in the water seal, or a high-flow system that can’t meet the patient’s inspiratory demand.

Initiation and Modification of Interventions (50 Items)

Half of the Breadth of Knowledge portion lives here, with 9 recall, 25 application, and 16 analysis items.

  • Maintain a patent airway (6): Positioning, airway selection, tracheostomy care, cuff management, and extubation.
  • Airway clearance and lung expansion (4): Postural drainage, suctioning, mechanical clearance devices, and hyperinflation therapy.
  • Support oxygenation and ventilation (10): Oxygen therapy, CPAP, invasive, noninvasive, and high-frequency ventilation, ventilator graphics, dyssynchrony, and liberation.
  • Medications and specialty gases (3): Aerosolized drugs, heliox, and inhaled nitric oxide.
  • Change the respiratory care plan (10): Recommending, adjusting, or stopping therapy and medications based on patient response.
  • Evidence-based practice (3): Therapist-driven protocols and national guidelines for ARDS, asthma, COPD, and cystic fibrosis.
  • High-risk situations (5): Resuscitation, rapid response, transport, and closed-loop communication.
  • Assist with procedures (4): Intubation, bronchoscopy, thoracentesis, and chest tube insertion.
  • Interact with the team, patients, and families (5): Escalating concerns, handoffs, and patient education.

Study tip: For each therapy, know the indication, expected response, complications, and when to stop or escalate.

What Is Covered in the Depth of Clinical Judgment Portion?

The Depth of Clinical Judgment portion replaces the CSE’s branching simulations with 60 standalone multiple-choice items. Each item is linked to a patient condition, a clinical judgment type, a setting, and a task from the Breadth of Knowledge portion.

  • Patient population: 50 adult items and 10 pediatric or neonatal items.
  • Clinical judgment type: 20 information-gathering items (choose what to assess or interpret information) and 40 decision-making items (decide what to add, modify, continue, or discontinue).
  • Setting: 46 items in a hospital and 14 outside a hospital.

Adult conditions include chronic lung disease (17 items, such as COPD, asthma, and cystic fibrosis), medical conditions (15 items, split among infectious disease, ARDS, and other conditions such as obesity or drug toxicity), cardiovascular disease (5), pre- and post-operative care (5), trauma (4), and neurologic or neuromuscular disease (4). Pediatric cases (4) include asthma, bronchiolitis, and congenital defects, and neonatal cases (6) focus on resuscitation and respiratory distress syndrome. Across the full 160 scored items, 15 to 18 involve neonatal or pediatric patients.

How Should You Use the Blueprint to Build a Study Plan?

Start with a mixed baseline quiz, then compare your weak areas with the item counts. Initiation and Modification of Interventions (50) and Depth of Clinical Judgment (60) together make up nearly 70% of the scored exam, so they deserve most of your time. Chronic lung disease and ARDS are high-yield within clinical judgment.

Each time you miss a question, tag it to an outline section. After a few weeks, patterns appear, such as ventilator troubleshooting or neonatal resuscitation, and you can target those areas instead of rereading everything.

What Official Resources Should You Use?

  • RT Examination Detailed Content Outline (January 2027): Your primary study map.
  • NBRC Candidate Handbook (September 2026): Eligibility, fees, scheduling, and exam-day policies.
  • NBRC RT Examination page: Official updates plus a free practice exam and paid Self-Assessment Examinations offered through PSI.
  • Commonly used references: Egan’s Fundamentals of Respiratory Care (13th ed.), The Ventilator Book (3rd ed.), The Comprehensive Respiratory Therapist Exam Review (7th ed.), and Respiratory Care Exam Review (5th ed.).

Frequently Asked Questions About the 2027 NBRC RT Exam

Does the RT Examination eliminate the CRT credential?
No. Reaching the low cut score earns the CRT, and reaching the high cut score earns the RRT.

What score do I need to pass?
The NBRC does not publish a percentage. Your total score on the 160 scored items is compared with the two cut scores. Aim for steady performance across both portions.

Is clinical judgment still tested without the CSE?
Yes. Sixty scored items measure clinical judgment, and 40 of those are decision-making items.

How soon will I get results?
Your score report is emailed after you finish. If it hasn’t arrived within 24 hours, contact PSI.

What if I don’t pass?
You may attempt the RT Examination three times without a waiting period. After that, you must wait at least 120 days between attempts. Repeat attempts cost $300.

I passed the TMC at the high cut score in 2026. What now?
You can take the CSE through December 31, 2027, or take the RT Examination and pass at the high cut score.

How do I keep my credential?
NBRC credentials are issued for five-year terms and maintained through the Credential Maintenance Program, which includes quarterly assessments and continuing education.

Start Preparing for the NBRC RT Exam With Pocket Prep

Pocket Prep’s 985 NBRC RT practice questions follow the new outline, including a dedicated Depth of Clinical Judgment subject, and every question includes a detailed explanation. Use Weakest Subject and Missed Questions to close gaps, then take a mock exam to practice pacing. With a clear plan and steady practice, you can walk into test day confident and ready.