NBRC NPS Exam 2026: What Respiratory Therapists Need to Know
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NBRC NPS Exam 2026: What Respiratory Therapists Need to Know
If you are a Registered Respiratory Therapist considering the Neonatal/Pediatric Specialty credential, the NBRC NPS Exam is your opportunity to demonstrate advanced knowledge in neonatal and pediatric respiratory care.
But this is not simply another respiratory therapy exam.
The NPS Examination focuses specifically on the assessment, treatment, monitoring, ventilation, airway management, emergency care, and critical care of neonatal and pediatric patients. That means preparing for it requires a different approach than studying for the TMC or CSE.
Whether you work in a NICU, PICU, pediatric emergency department, children's hospital, transport team, or are preparing to transition into neonatal and pediatric respiratory care, understanding the current NPS exam blueprint should be the first step in your study plan.
Here is what you need to know about the NBRC Neonatal/Pediatric Specialty Examination in 2026.
What Is the NBRC NPS Exam?
The Neonatal/Pediatric Specialty Examination, commonly called the NPS Exam, is administered by the National Board for Respiratory Care.
Passing the examination allows qualified respiratory therapists to earn the RRT-NPS specialty credential.
The credential recognizes respiratory therapists who demonstrate specialized knowledge in caring for neonatal and pediatric patients.
Unlike the general respiratory therapy credentialing exams, the NPS Exam goes much deeper into topics such as neonatal respiratory disease, pediatric critical care, congenital heart disease, advanced ventilation, neonatal resuscitation, pediatric resuscitation, airway emergencies, specialty gases, ECMO, surfactant therapy, and other areas encountered in neonatal and pediatric respiratory care.
Who Can Take the NPS Exam?
To qualify for the current NPS Examination, you must hold the Registered Respiratory Therapist credential.
In other words, you must be an RRT before applying for the NPS specialty examination.
This makes NPS an advanced specialty credential rather than an entry-level respiratory therapy credential.
How Many Questions Are on the NPS Exam?
The current NBRC NPS Examination contains:
170 total multiple-choice questions
150 scored questions
20 pretest questions
4 hours of testing time
The 20 pretest questions are not included in your final score, but they are mixed throughout the examination. You will not know which questions are scored and which are pretest questions.
For that reason, treat every question as though it counts.
With four hours for 170 questions, you have an average of approximately 85 seconds per question. Some questions will take much less time, while clinical application questions may require more careful analysis.
The NPS Exam Is More Than Memorization
One of the biggest mistakes candidates can make is preparing for the NPS Exam by memorizing facts without learning how to apply them.
The current NBRC content outline places a major emphasis on integration-level questions.
On the 150 scored questions, the blueprint includes approximately:
22 recall-level questions
128 integration-level questions
That means the majority of the examination requires you to apply or analyze information rather than simply recognize a definition or normal value.
You may need to look at a patient's age, diagnosis, blood gas, oxygenation status, ventilator settings, physical assessment, imaging findings, and vital signs before deciding what the respiratory therapist should do next.
Knowing the facts is important.
Knowing what to do with those facts is even more important.
What Is Tested on the NBRC NPS Exam?
The 150 scored questions are divided into two major areas.
1. General and Critical Care Competencies
Approximately 80 scored questions cover competencies shared between general and critical care of neonatal and pediatric patients.
These areas include:
Patient assessment
Medical and surgical history
Physical examination
Laboratory interpretation
Imaging
Respiratory physiology
Gas exchange
Pulmonary function
Airway management
Artificial airways
Oxygen administration
Aerosol therapy
Respiratory equipment
Home respiratory equipment
Bronchoscopy and procedures
Blood gas sampling
Respiratory medications
Diagnostic testing
Nutrition and feeding concerns
Neonatal and pediatric resuscitation
Patient-care protocols
Interdisciplinary communication
Patient and family education
Do not overlook these topics simply because they appear less advanced than mechanical ventilation. Together, they represent more than half of the scored NPS examination.
2. Neonatal and Pediatric Critical Care
Approximately 70 scored questions focus specifically on the critical care of neonatal and pediatric patients.
This is where the NPS Exam becomes significantly more specialized.
The blueprint includes areas such as:
Maternal history
Fetal and neonatal assessment
APGAR scoring
Specialty gas administration
Inhaled nitric oxide
Helium-oxygen mixtures
Mechanical ventilation
Noninvasive ventilation
Advanced oxygenation monitoring
Prone positioning
Extracorporeal life support
Ventilator waveforms
Pulmonary mechanics
Patient-ventilator interaction
Ventilator liberation
Prevention of ventilator-induced lung injury
Advanced airway procedures
Chest tubes
Needle decompression
ECMO-related care
Therapeutic hypothermia
Surfactant replacement therapy
Neuromuscular blocking medications
End-of-life care
These are areas where understanding clinical decision-making becomes extremely important.
Mechanical Ventilation Is a Major Part of the NPS Exam
If there is one area candidates should not neglect, it is neonatal and pediatric ventilation.
According to the current NBRC NPS blueprint, Manage Ventilation and Oxygenation accounts for approximately 30 scored questions.
That makes it the largest individual content category on the examination.
You should be comfortable with:
Initial ventilator settings
Pressure-controlled ventilation
Volume-targeted ventilation
Conventional mechanical ventilation
Noninvasive ventilation
High-frequency ventilation concepts
PEEP
Mean airway pressure
Tidal volume
Minute ventilation
Oxygenation versus ventilation problems
Compliance and resistance
Ventilator waveforms
Patient-ventilator synchrony
PaO2/FIO2 ratio
SaO2/FIO2 ratio
Oxygenation Index
Oxygen Saturation Index
Ventilator-induced lung injury
Ventilator weaning and liberation
You should also understand how ventilator management changes depending on the disease process.
A premature infant with respiratory distress syndrome is not managed the same way as a child with severe asthma, pediatric ARDS, bronchiolitis, congenital heart disease, or neuromuscular weakness.
The examination expects you to recognize those differences.
Know Your Neonatal and Pediatric Diseases
The NBRC blueprint includes a broad range of neonatal and pediatric conditions.
Important pulmonary conditions include:
Meconium aspiration syndrome
Persistent pulmonary hypertension of the newborn
Neonatal pneumonia
Asthma
Chronic lung disease of prematurity
Respiratory distress associated with prematurity
Apnea of prematurity
Bronchiolitis
Pediatric ARDS
Croup
Cystic fibrosis
Pediatric airway disorders
Congenital respiratory abnormalities
Inhalation injuries
You should also prepare for non-pulmonary disorders that affect respiratory management, including:
Congenital heart disease
Heart failure
Shock
Neurologic disorders
Neuromuscular disorders
Trauma
Sleep-related disorders
Immunocompromised patients
Congenital abnormalities
The key is not simply recognizing each condition.
Ask yourself:
What does this patient look like?
What assessment findings should I expect?
What diagnostic findings support the diagnosis?
What respiratory treatment is indicated?
What treatment would be inappropriate?
When should respiratory support be escalated?
When can support safely be decreased?
That is the type of thinking that prepares you for application-based questions.
Do Not Ignore Congenital Heart Disease
Congenital heart disease is another area that deserves serious attention.
Respiratory therapists preparing for the NPS should understand the major differences between cyanotic and acyanotic congenital heart defects and how those defects influence oxygenation, pulmonary blood flow, systemic blood flow, and respiratory management.
Important concepts can include:
Patent ductus arteriosus
Ventricular septal defect
Atrial septal defect
Tetralogy of Fallot
Transposition of the great arteries
Coarctation of the aorta
Hypoplastic left heart syndrome
Single-ventricle physiology
You should understand more than the name of the defect. Focus on physiology and what happens to blood flow.
If you understand the physiology, many difficult congenital heart questions become much easier.
NRP and PALS Concepts Matter
The current blueprint specifically includes resuscitation and protocols such as Neonatal Resuscitation Program and Pediatric Advanced Life Support concepts.
Candidates should be comfortable recognizing when a newborn or child requires respiratory intervention and selecting appropriate equipment and therapy.
That can include:
T-piece resuscitators
Self-inflating bags
Flow-inflating bags
Supraglottic airways
Oxygen administration
Positive-pressure ventilation
Airway management
Assessment of ventilation effectiveness
Escalation during cardiopulmonary deterioration
The goal is not simply memorizing an algorithm. You need to understand why each intervention is performed and recognize the clinical findings that indicate when to move to the next step.
How Much Does the NPS Exam Cost?
The NBRC currently lists the NPS Examination fee as:
$250 for a first attempt
$220 for a repeat attempt
Candidates should always verify current fees directly with the NBRC before registering because examination fees and policies can change.
What Happens If You Do Not Pass?
Specialty examinations have different repeat-attempt rules than the TMC and CSE.
For the NPS Examination, candidates currently receive two attempts before the NBRC waiting-period rule applies.
After those attempts, a candidate must wait at least 180 days before each subsequent attempt.
This makes preparation especially important.
Instead of repeatedly taking the exam hoping to see familiar material, identify your weak areas before test day and work on them systematically.
How Should You Study for the NPS Exam?
A strong NPS study plan should combine content review with application-based practice.
Step 1: Start With the NBRC Content Outline
The NBRC Detailed Content Outline is essentially your roadmap.
Use it as a checklist.
If the NBRC specifically lists a disease, procedure, medication, measurement, or clinical skill, make sure you understand it.
Step 2: Learn Normal Values
You should be comfortable with neonatal and pediatric normal values, including values that change based on age and weight.
Know important:
Vital signs
Blood gas values
Airway sizes
Endotracheal tube considerations
Tidal volumes
Oxygenation measurements
Hemodynamic concepts
Pulmonary mechanics
Medication concepts
Calculations and formulas
Understanding normal values helps you quickly recognize when something is wrong.
Step 3: Focus Heavily on Mechanical Ventilation
Do not save ventilators for the end of your study plan.
Study them early and revisit them frequently.
Learn how changes in PEEP, respiratory rate, inspiratory pressure, tidal volume, inspiratory time, FIO2, and mean airway pressure affect the patient.
Then practice applying those concepts to neonatal and pediatric cases.
Step 4: Practice Clinical Questions
Reading alone can create a false sense of confidence.
You might recognize a topic when reading a study guide but still struggle when it appears inside a clinical scenario.
Practice questions force you to retrieve information and make decisions.
When you miss a question, do not just memorize the correct answer.
Ask yourself why the correct answer is correct and why the other choices are wrong.
That is where the learning happens.
Step 5: Review Your Weakest Areas
Your study time should not be divided equally between every subject.
If congenital heart disease is your weakest area, spend more time there.
If ventilation is your weakness, work ventilator questions until you can recognize the relationship between the patient, disease process, ventilator settings, and blood gas without relying on memorized tricks.
Study based on what you need — not simply what you enjoy studying.
Preparing for the NPS Exam With RRTNOW
RRTNOW created its NPS resources specifically for respiratory therapists preparing for neonatal and pediatric specialty testing.
Our NPS preparation resources include options such as:
A comprehensive NPS study guide
Digital NPS review material
A full-length 170-question NPS practice examination
Detailed answer rationales
Study Mode with immediate feedback
Exam Mode for a more realistic testing experience
Normal-value and formula references
Focused neonatal and pediatric review
Advanced cardiac and ventilator content
The goal is not simply to give you more information.
It is to help you organize what you need to know and practice using that knowledge the way you may be asked to use it on an examination.
Final Thoughts
The NBRC NPS Exam is challenging because neonatal and pediatric respiratory care requires more than memorizing respiratory therapy facts.
You must recognize clinical patterns, understand neonatal and pediatric physiology, interpret diagnostic information, manage airways, understand medications, troubleshoot equipment, evaluate oxygenation and ventilation, and determine the most appropriate next intervention.
Start with the NBRC blueprint.
Know your neonatal and pediatric disease processes.
Become comfortable with congenital heart disease.
Master mechanical ventilation and oxygenation.
Know your normal values.
And most importantly, practice applying what you know to realistic clinical scenarios.
Preparation should give you more than memorized information.
It should teach you how to think through the question.
Prepare for success with RRTNOW.