The New NBRC RTE Exam Is Coming in 2027 and RRTNOW Will Be Ready

A major change is coming to respiratory therapy credentialing. Beginning January 1, 2027, the National Board for Respiratory Care will introduce a single examination for candidates seeking the Certified Respiratory Therapist or Registered Respiratory Therapist credential.

Many students are calling it the “RTE,” but its official name is the Respiratory Therapy Examination, abbreviated by the NBRC as the RT Examination.

Instead of completing the Therapist Multiple-Choice Examination and then qualifying for the Clinical Simulation Examination, most new candidates will complete one comprehensive multiple-choice exam. The goal is to evaluate both respiratory care knowledge and the ability to make safe clinical decisions.

Here is what future RT students need to know—and how RRTNOW is preparing to help.

What Is Changing With the New NBRC Exam?

Under the current system, candidates take the TMC Examination first. Candidates who reach the high cut score can then become eligible for the CSE to pursue the RRT credential.

The new RT Examination combines these concepts into one testing experience. According to the official NBRC examination information, the new exam will include:

• 185 total multiple-choice questions

• 160 scored questions

• 25 unscored pretest questions

• A four-hour testing limit

• One cut score for the CRT credential

• A higher cut score for the RRT credential

• An examination fee of $360 for new applicants

• An examination fee of $300 for repeat applicants

Candidates who reach the lower passing standard will earn the CRT credential. Candidates who reach the higher passing standard will earn the RRT credential.

This means a candidate may earn the RRT credential by reaching the high cut score on one examination instead of passing two separate exams.

How Will the New RTE Be Structured?

The 160 scored questions are divided into two major portions: Breadth of Knowledge and Depth of Clinical Judgment.

Breadth of Knowledge: 100 Questions

This portion evaluates the respiratory care knowledge and skills candidates are expected to use in clinical practice. The 2027 NBRC Detailed Content Outline divides these questions into three major areas:

• Patient Data: 25 questions

• Management of Devices and Patient Safety Procedures: 25 questions

• Initiation and Modification of Interventions: 50 questions

Candidates should expect content involving patient assessment, laboratory results, blood gases, pulmonary function testing, imaging, mechanical ventilation, airway management, oxygen therapy, medications, infection prevention, equipment troubleshooting and patient education.

However, this portion will not be based on memorization alone. The official outline assigns most of these questions to application and analysis. Candidates must understand how to use respiratory care information—not simply recall isolated facts.

Depth of Clinical Judgment: 60 Questions

The clinical judgment portion brings important concepts from the current CSE into a multiple-choice format. These will be independent multiple-choice questions rather than branching clinical simulations.

The 60 scored clinical judgment questions include:

• 20 information-gathering questions

• 40 decision-making questions

• 46 questions involving hospital settings

• 14 questions involving settings outside the hospital

Candidates will be tested on adult, pediatric and neonatal patients. Clinical situations may involve chronic lung disease, acute respiratory disorders, cardiac conditions, trauma, neurological conditions, postoperative care, neonatal resuscitation and neonatal respiratory distress syndrome.

The candidate may need to determine:

• Which information should be gathered first

• Which assessment finding is most important

• Whether a treatment should be started

• How therapy should be modified

• Whether an intervention should be continued or discontinued

• Which action is safest for the patient

• When care should be escalated

This is one of the most important changes. Clinical judgment will no longer be limited to candidates taking a separate simulation examination. It will be an essential part of the single RT Examination.

Is the New Exam Expected to Be Easier?

The new exam should not be viewed as an easier version of the TMC and CSE. The NBRC has stated that it intends to maintain the existing standards associated with both the CRT and RRT credentials.

Although candidates will take one exam instead of two, they will still need to demonstrate a strong foundation in respiratory care and the ability to apply that knowledge to realistic patient situations.

Successful preparation will require more than memorizing normal values, formulas and definitions. Candidates must practice recognizing patterns, prioritizing information and choosing the safest clinical response.

What About Students Testing During the Transition?

Applications for the new RT Examination are scheduled to open on October 1, 2026, and the examination will become available on January 4, 2027.

The last day to apply for the current TMC Examination is December 15, 2026, and the last day to take it is December 31, 2026.

Candidates who pass the TMC at the high cut score before the end of 2026 may continue taking the CSE through December 31, 2027. Eligible candidates may also choose to take the new RT Examination and earn the RRT credential by reaching its high cut score.

Students should carefully review their testing timeline and current eligibility before deciding which pathway is right for them.

How RRTNOW Is Preparing for the New RTE

RRTNOW will be ready for the 2027 examination transition.

We are reviewing the official NBRC content outline and adapting our preparation materials to match the structure, clinical expectations and updated content of the new Respiratory Therapy Examination.

Our updated RTE preparation system will focus on:

• The complete 2027 NBRC content outline

• Breadth-of-knowledge questions covering all three major domains

• Clinical judgment questions based on information gathering and decision making

• Adult, pediatric and neonatal respiratory care

• Hospital and out-of-hospital patient situations

• Mechanical ventilation, airway management and oxygen therapy

• Patient assessment, diagnostics and data interpretation

• Equipment troubleshooting and patient safety

• Clear explanations for why each answer is correct

• Full-length practice testing designed for the new exam format

• Live interactive feedback that helps students learn from mistakes immediately

RRTNOW will continue supporting students taking the current TMC and CSE during the transition while developing dedicated resources for candidates preparing for the new examination.

Our goal remains the same: to make difficult respiratory therapy concepts easier to understand and help students develop the clinical thinking needed to prepare with confidence.

How Students Can Start Preparing Now

Students do not need to wait until 2027 to begin building the skills required for the new exam.

Start by strengthening the areas that will remain essential:

• Patient assessment and prioritization

• ABG interpretation

• Mechanical ventilation

• Oxygenation and ventilation problems

• Airway management

• Respiratory medications

• Equipment troubleshooting

• Neonatal and pediatric respiratory care

• Information gathering

• Clinical decision making

Do not study facts in isolation. Ask yourself what each finding means, which information matters most and what the respiratory therapist should do next.

That is the type of thinking the new exam is designed to measure.

RRTNOW Is Moving Forward With You

Changes to the credentialing process can feel overwhelming, but students will not have to navigate them alone.

RRTNOW is committed to staying current with official NBRC updates and creating preparation materials that reflect the new examination—not outdated testing methods. As additional information becomes available, our study guides, practice questions and interactive exams will continue to be updated.

The exam may be changing, but our commitment to helping future respiratory therapists prepare for success is not.

Stay connected with RRTNOW for upcoming RTE study guides, practice exams, exam updates and respiratory therapy education.

RRTNOW is an independent respiratory therapy education company and is not affiliated with or endorsed by the National Board for Respiratory Care.