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Written and reviewed by a Registered Respiratory Therapist (RRT-NPS) with 18+ years of bedside experience in NICU, PICU, CVICU, and adult critical care. Last updated August 2026.
If you are preparing for the NBRC board exams right now, you are studying during the single biggest change to respiratory therapy credentialing in a decade. The Therapist Multiple-Choice (TMC) Examination retires at the end of 2026, and a new single Respiratory Therapy (RT) Examination replaces both the TMC and the Clinical Simulation Examination beginning January 2027.
This guide covers exactly what is on each exam, how scoring works, what it costs, and — most importantly — which exam you will actually sit for based on where you are in your program. Every number below comes straight from the NBRC's published Detailed Content Outlines and official FAQs, not from secondhand summaries.
Time-sensitive: The last date applications will be accepted for the TMC Examination is December 15, 2026, and the last day to take it is December 31, 2026. If you are graduating in 2026 and want the TMC pathway, your window is closing.
What this guide covers
The dates below are the ones that decide your pathway. Miss one and your route to the RRT credential changes.
Already attempted the TMC or CSE more than once? That history does not follow you. The NBRC has confirmed that the number of attempts previously made on the TMC and CSE Examinations will not count toward attempts on the Respiratory Therapy Examination.
The Therapist Multiple-Choice Examination is the entry point to the profession. It measures the essential knowledge, skills, and abilities required of respiratory therapists at entry into practice, and it does double duty: it awards the CRT credential and determines whether you become eligible for the Clinical Simulation Exam.
| Total items | 160 multiple-choice items — 140 scored and 20 pretest |
|---|---|
| Time limit | 3 hours |
| Fee | $190 first attempt / $150 repeat attempt |
| Attempts | 3 attempts with no waiting period, then a minimum 120 days between subsequent attempts |
| Content outline | TMC Detailed Content Outline, effective January 2020 through December 31, 2026 |
| Where you test | PSI assessment centers — more than 300 nationwide, Monday through Saturday |
| Results | Pass/fail appears on screen immediately; the full score report is emailed within 24 hours |
Those 20 pretest items matter more than most candidates realize. They are unscored questions the NBRC is trialing for future exams, and they are not identified on screen. You cannot tell which ones count. That is why a question that feels bizarre or unfamiliar is not necessarily a question you were supposed to know — and why panicking over one item is wasted energy.
The standard route: be 18 years of age or older, and be a graduate of — and hold a minimum of an associate degree from — an entry-into-practice respiratory therapy education program supported or accredited by CoARC. Alternate CRT-to-Registry routes exist for currently credentialed CRTs, but those expire December 31, 2026.
This is the table to build your study plan around. Section III alone is half the exam. If your review time is limited, weight it accordingly.
| Content area | Recall | Application | Analysis | Total items |
|---|---|---|---|---|
| I. Patient Data | 15 | 27 | 8 | 50 |
| II. Troubleshooting and Quality Control of Devices, and Infection Control | 8 | 9 | 3 | 20 |
| III. Initiation and Modification of Interventions | 10 | 30 | 30 | 70 |
| Totals | 33 | 66 | 41 | 140 |
Source: NBRC Therapist Multiple-Choice Examination Detailed Content Outline, effective January 2020.
Two things jump out of that grid. First, only 33 of 140 items are pure recall — roughly three-quarters of the exam asks you to apply or analyze, not remember. Memorizing normal values will not carry you. Second, Section III splits 30/30 between application and analysis, which is where most candidates lose points: the exam wants to know what you would do next, not what a mode is called.
The blueprint also sets age-mix rules. Pediatric items (1 month to 17 years) carry a target of 4 per form with a minimum of 3 and a maximum of 8, and neonatal items (birth to 1 month) target 3 with a minimum of 2 and a maximum of 5. Neonatal and pediatric content is a small slice of the TMC — but it is guaranteed to appear, and it is commonly the slice students skip.
The TMC has two passing standards, not one. If you achieve the low cut score you earn the CRT credential. If you achieve the high cut score you earn the CRT credential and become eligible for the Clinical Simulation Examination, provided you meet the eligibility requirements.
In its guidance for candidates credentialed in Canada, the NBRC states that earning the RRT credential requires passing the TMC at the high cut score, described as 92 or above. Against 140 scored items, that works out to roughly 66%.
An honest note on the low cut score. You will see prep sites confidently publish a low cut score — some say 86, others say 88. The NBRC does not publish that figure alongside the high cut score, and cut scores are set by psychometric standard-setting rather than fixed forever. Anyone quoting you a number as permanent gospel is overreaching. Check the current NBRC Candidate Handbook for the figure in effect when you test, and in the meantime aim well past the high cut score — that is the only target that opens the RRT pathway anyway.
One clarification that saves a lot of anxiety: hitting the high cut score does not automatically make you CSE-eligible. The NBRC is explicit that you must still meet the CSE eligibility requirements regardless of your examination score. And if you already hold the CRT and score below the low cut on a retake, you do not lose your existing CRT credential.
The CSE is the second half of the classic RRT pathway, and it is a fundamentally different animal from the TMC. It consists of 22 problems — 20 scored and 2 pretest — and you are given four hours to complete it. The clinical setting and patient situation for each problem are designed to simulate reality and be relevant to the clinical practice of respiratory care. The fee is $200 for both first and repeat attempts, and like the TMC, you get three attempts before a 120-day wait applies.
Each branching scenario is scored in two separate categories:
You must pass both categories. Strong DM will not rescue weak IG, which is why candidates who "know their stuff" still fail: they jump to the intervention without gathering the data that justifies it. The exam is modeling a therapist who assesses before acting.
A practical habit worth building now: in every scenario, ask yourself what would I need to see at the bedside before I'd be comfortable doing this? Then select exactly that, and nothing decorative.
AARC members are eligible for a one-time $40 discount when applying for the first time to the CSE, PFT, NPS, SDS, ACCS, or AE-C examinations. Note that the TMC is not on that list, and the discount must be applied at the time you submit your application — it will not be applied retroactively.
Beginning January 2027, one exam replaces two. The NBRC Board of Trustees voted in April 2022 to transition to a single examination in order to reduce barriers for graduates entering the profession while maintaining the standards associated with the CRT and RRT credentials — a continuation of the 2015 change that removed the second multiple-choice exam from the RRT pathway.
| TMC + CSE (through 2026) | RT Exam (from Jan 2027) | |
|---|---|---|
| Number of exams | Two | One |
| Items | 160 TMC (140 scored) + 22 CSE problems | 185 items — 160 scored, 25 pretest |
| Time | 3 hours + 4 hours | 4 hours |
| Format | Multiple choice + branching simulations | All multiple choice |
| First-attempt cost | $390 combined | $360 (a $30 saving) |
| Repeat cost | $350 combined | $300 (a $50 saving) |
| How credentials are awarded | TMC low cut = CRT; high cut + passing CSE = RRT | Low cut score earns CRT; high cut score earns RRT |
The RT Exam is built in two portions that are combined into a single form. The Breadth of Knowledge portion contains 100 items and the Depth of Clinical Judgement portion contains 60 items. There is one total score — you do not pass each portion separately.
Breadth of Knowledge — 100 items
| Content area | Recall | Application | Analysis | Total |
|---|---|---|---|---|
| I. Patient Data | 6 | 15 | 4 | 25 |
| II. Management of Devices and Patient Safety Procedures | 8 | 12 | 5 | 25 |
| III. Initiation and Modification of Interventions | 9 | 25 | 16 | 50 |
| Totals | 23 | 52 | 25 | 100 |
Depth of Clinical Judgment — 60 items. This is the portion that absorbs what the CSE used to test. Each item is linked to a patient condition, a clinical judgment type, and a setting, plus a task statement from the Breadth of Knowledge portion, and complexity is limited to the application or analysis cognitive levels.
| Patient condition | Items per form |
|---|---|
| Adults — Chronic lung disease (COPD, asthma, restrictive disease, bronchiectasis, CF) | 17 |
| Adults — Medical (infectious disease 5, ARDS 5, other 5) | 15 |
| Adults — Cardiovascular | 5 |
| Adults — Pre- and post-operative care | 5 |
| Adults — Trauma | 4 |
| Adults — Neurological or neuromuscular | 4 |
| Children — Neonatal (resuscitation 3, RDS 3) | 6 |
| Children — Pediatric | 4 |
| Total | 60 |
Three further specifications shape every form, and they tell you a great deal about how to prepare:
That last figure is the single biggest shift for students. On the TMC, neonatal and pediatric content targets roughly 7 items. On the RT Exam it is 15 to 18 out of 160 — more than double. If neonatal resuscitation and RDS management have been your weak spot, that gap is no longer survivable.
The content itself has also been refreshed. The 2027 outline explicitly names social determinants of health and barriers to healthcare, trauma-informed and culturally aware care, closed-loop communication, debriefing following adverse patient events, handoffs, antifibrinolytics, biologics for asthma such as dupilumab, and CFTR modulators such as elexacaftor/tezacaftor/ivacaftor. Meanwhile diagnostic chest percussion, which appears in the current TMC outline, is gone. Medical ethics is woven throughout: each minipool carries at least 5 ethics-linked items in the Breadth portion and at least 3 in the Depth portion.
Find yourself below.
| Your situation | Your pathway |
|---|---|
| Graduating and testing before December 31, 2026 | TMC, then CSE if you hit the high cut score. Apply by December 15, 2026. |
| Graduating in 2027 or later | The RT Exam. One sitting decides both CRT and RRT. |
| Passed the TMC at the high cut score but have not yet passed the CSE | You may sit the CSE through December 31, 2027 — or take the RT Exam and pass at the high cut score to earn the RRT from January 1, 2027. |
| Passed the TMC at the low cut score only (CRT held) | If you hold an associate degree or higher from a CoARC-supported entry-into-practice program, you are eligible for the RT Exam. |
| CRT without a CoARC associate degree | CRT-to-Registry routes close December 31, 2026. After that, the CoARC associate degree becomes mandatory. Act now if this is you. |
Content knowledge and exam performance are two different skills. Plenty of excellent students fail these exams, and it is almost never because they did not know enough physiology.
The Detailed Content Outline is the actual specification the exam is assembled from. Print it and mark every task you could not confidently teach to a first-year student. That list — not the textbook's table of contents — is your study plan.
Since roughly three-quarters of TMC items sit at application or analysis level, flashcards alone under-prepare you. Work questions that hand you a scenario and force a decision. When you review, do not stop at "I got it right." Articulate why the three distractors are wrong — that is the reasoning the exam is actually scoring.
A large share of items reduce to a handful of repeating skills: interpreting an arterial blood gas and naming the acid-base disturbance with compensation, reading a ventilator waveform, deciding whether a problem is a lung problem or a machine problem, choosing the least invasive effective intervention, and recognizing when to stop a therapy. Build genuine fluency in those and you have covered enormous ground. If ABG interpretation is where you slow down, our ABG Interpreter tool is built to drill exactly that pattern.
Three hours of sustained clinical reasoning is a physical challenge as much as an intellectual one. Sit at least two complete timed practice exams before test day so that fatigue is not a new variable. RRTNOW's full-length practice exams are built to the blueprint proportions above so your practice score means something.
The NBRC offers free practice examinations for every credential, including an RT Practice Examination for the January 2027 format, and paid Self-Assessment Examinations through PSI. The official SAEs are the only products that provide the examination committees' own rationale for the best response to each question — that makes them worth the money regardless of what else you use.
The TMC Examination contains 160 multiple-choice items — 140 scored and 20 pretest — taken over a three-hour period. The pretest items are unscored and are not identified during the exam.
The TMC uses two cut scores. The low cut score earns the CRT credential; the high cut score earns the CRT and eligibility for the Clinical Simulation Exam. The NBRC describes the high cut score as 92 or above out of 140 scored items, roughly 66%. The low cut score is not published in the same place, so confirm the current figure in the NBRC Candidate Handbook.
Yes. The final day to apply for the TMC is December 15, 2026, and the final day to take it is December 31, 2026. It is replaced by the Respiratory Therapy Examination beginning January 4, 2027.
A single Respiratory Therapy (RT) Examination. It consists of 185 multiple-choice items — 160 scored and 25 pretest — over four hours, and costs $360 for new applicants and $300 for repeat applicants. The low cut score earns the CRT credential and the high cut score earns the RRT credential.
The CSE consists of 22 problems — 20 scored and 2 pretest — completed within four hours. Each problem is scored separately for Information Gathering and Decision Making, and both categories must be passed.
The TMC is $190 first attempt and $150 repeat. The Clinical Simulation Exam is $200 for both first and repeat attempts. The NPS is $250/$220, PFT $200/$170, ACCS $300/$250, SDS $300/$250, and AE-C $350/$250. AARC members receive a one-time $40 discount on first-time application to the CSE, PFT, NPS, SDS, ACCS, and AE-C exams.
You may attempt the TMC and CSE three times without waiting, after which a minimum of 120 days is required between subsequent attempts. The same policy applies to the new RT Examination, and attempts on the TMC or CSE do not count toward attempts on the RT Exam.
No. The NBRC confirms that scoring below the low cut score on a retake does not affect the status of a CRT credential you already hold, and you may retake as many times as needed to earn the RRT.
Your pass/fail result appears on screen immediately after you finish, and the full score report is emailed within 24 hours.
By weight and cognitive demand, Section III — Initiation and Modification of Interventions. It carries 70 of 140 scored items and splits 30 application and 30 analysis, meaning almost none of it can be answered by recall alone.
All examination specifications on this page are taken from official National Board for Respiratory Care publications: the Therapist Multiple-Choice Examination Detailed Content Outline (effective January 2020), the Respiratory Therapy Examination Detailed Content Outline (effective January 2027), and the NBRC Resources and Examinations FAQ pages. Verify current figures at nbrc.org/resources before applying, as fees, dates, and standards are set by the NBRC and may change. RRTNOW is an independent educational publisher and is not affiliated with or endorsed by the NBRC. CRT, RRT, and related designations are registered trademarks of the National Board for Respiratory Care.