NBRC Exam Changes 2027: The New Respiratory Therapy Exam
In 2027 the National Board for Respiratory Care (NBRC) introduces one Respiratory Therapy (RT) Examination, with testing beginning January 4, 2027: the low cut earns the Certified Respiratory Therapist (CRT) credential, and the high cut earns the Registered Respiratory Therapist (RRT) credential. The Therapist Multiple-Choice Examination (TMC) ends December 31, 2026; the Clinical Simulation Examination (CSE) stays open through December 31, 2027, but only for people who pass the TMC at the high cut score by the end of 2026 and still meet CSE eligibility rules. (NBRC RT Examination page, NBRC examinations list, CSE page)
What the change means for you
Find the row that matches your record today.
| Your situation | What applies to you | Your next step |
|---|---|---|
| You're eligible for the TMC and can test by December 31, 2026 | The TMC is still an option until its last test day. A low cut earns the CRT. A high cut earns the CRT and can qualify you for the CSE through 2027 if you meet its other eligibility requirements. | Apply early (see the cutoff note under Key dates) and book a seat you can actually get. Or skip the TMC and take the RT Exam from January 4, 2027, if you meet its admission requirements. |
| Your first CRT/RRT examination will be in 2027 | You take the RT Exam if you meet its admission requirements. One sitting decides CRT, RRT, or neither. | Check the RT admission requirements and study to the outline effective January 2027. |
| You passed the TMC at the low cut only and want the RRT | A low-cut pass does not open the CSE. You can retake the TMC to reach the high cut through December 31, 2026, subject to eligibility and the retake waiting rules. After that, you can earn the RRT through the RT Exam's high cut if you meet its admission requirements. (Indiana PLA posting of the NBRC transition notice, Sept. 10, 2026) | Decide whether another TMC attempt fits by December 31, or prepare for the RT Exam. You keep your CRT either way. |
| You passed the TMC at the high cut by December 31, 2026 and still need the RRT | Two routes, subject to their admission requirements: pass the CSE by December 31, 2027, or take the RT Exam and reach the high cut. Choose before you apply: the transition notice says that once you apply for the RT Exam, you can no longer apply for the CSE. (Indiana PLA posting) | Compare your readiness for each format, then confirm your choice with NBRC before submitting an RT application. |
| You're a CRT relying on an older CRT-to-Registry route without qualifying CoARC education | That pathway ends December 31, 2026. A CRT without the RRT by January 1, 2027 must meet the new RT admission requirements; the former CRT-to-Registry provision does not qualify them. The official sources checked do not clearly resolve whether this group keeps CSE access in 2027. (NBRC notice) | Get NBRC's answer for your own record now, before relying on a 2027 CSE date. |
| You already hold the CRT or RRT and aren't testing again | You don't retest because the exam changed. NBRC says the Credential Maintenance Program stays based on the credentials you hold. (NBRC RT FAQ) | Keep up your maintenance and state license. Note NBRC's separate change: starting in payment year 2027, the CMP fee is $150 over the five-year credential term, collected in $30 annual payments. (NBRC Resources FAQ) |
The CSE retake squeeze. The CSE allows three attempts without a long wait, then 120 days between later attempts (NBRC repeat attempt policy). A wait never extends the exam's life. Someone who uses three CSE attempts in mid-to-late 2027 may have no fourth attempt before the CSE ends. If you hold a TMC high-cut pass, plan your CSE date early rather than late.
Coming back after a long gap? An old high-cut result does not by itself establish current eligibility. NBRC considers an application inactive after one year with neither an examination scheduled nor any indication that the applicant wants to test. Reentry requires a new application and fee plus documentation of eligibility under current admission rules. (NBRC Candidate Handbook, rev. Sept. 3, 2026, p. 10)
By the Castleport Test Prep Editorial Team. NBRC exam formats, dates, fees, eligibility notices, and content outlines last verified October 30, 2026.
Key dates
| Date | What happens |
|---|---|
| October 1, 2026 | RT Exam applications opened (application date, not a test date) |
| December 15 or 17, 2026 | Last day NBRC accepts TMC applications. NBRC's two FAQs disagree: the RT page says December 15; the Resources FAQ says December 17 |
| December 31, 2026 | Last day to take the TMC. CRT-to-Registry pathway ends. Deadline to reach the TMC high cut for the transitional CSE route, subject to its other eligibility requirements |
| January 1, 2027 | RT Exam policy takes effect |
| January 4, 2027 | First RT Exam testing day |
| December 31, 2027 | CSE ends |
Plan around December 15. Applying by the earlier date falls within both published cutoffs. If your plan depends on December 16 or 17, confirm with NBRC first. Two more traps:
- An accepted NBRC application normally gives you 90 calendar days to test (Handbook p. 8), but the TMC ends December 31 regardless. A mid-December application leaves you about two weeks, and seats are not guaranteed.
- The CSE-specific page says "by" December 31, 2026; the general RT FAQs say "prior to" that date. If December 31 is your only TMC date, ask NBRC whether a high-cut pass that day keeps the CSE open.
TMC, CSE, and the RT Exam compared
| Comparison point | TMC | CSE | RT Examination |
|---|---|---|---|
| Format | Multiple choice | Clinical simulation problems | Multiple choice (standalone items) |
| Items | 160 (140 scored, 20 pretest) | 22 problems (20 scored, 2 pretest) | 185 (160 scored, 25 pretest) |
| Time | 3 hours | 4 hours | 4 hours |
| What passing earns | Low cut: CRT. High cut: CRT plus CSE eligibility if otherwise qualified | RRT (for eligible candidates) | Low cut: CRT. High cut: RRT |
| First-attempt fee | $190 | $200 | $360 |
| Repeat fee | $150 | $200 | $300 |
| Availability | Ends Dec. 31, 2026 | Ends Dec. 31, 2027 | Starts Jan. 4, 2027 |
Sources: TMC page, CSE page, RT page, Candidate Handbook p. 8. Pretest items don't count toward your score.
What it costs. Under the old route, a first attempt at both exams cost $190 + $200 = $390; the RT Exam's first-attempt fee is $360, which is NBRC's stated $30 saving. If you've already passed the TMC, compare what's left: $200 for the CSE versus the RT fee. The sources checked do not spell out which RT fee applies to someone who took the TMC or CSE before, so check the fee category when you apply. These figures are exam fees only, before any discounts and state licensing costs.
Does the high cut really earn the RRT without a CSE? Yes. On the RT Exam there is one overall CRT passing standard and one overall RRT passing standard — not a separate pass mark for each part of the exam (NBRC announcement). NBRC's published Accuracy of a Testing Result, Part 1, p. 3, Table 1 lists RT cut scores of 100 correct scored answers for CRT and 106 for RRT, out of 160 scored items.
Eligibility: does anything change, and is the CRT going away?
The CRT is not going away. NBRC says it will keep supporting the CRT credential. What ends is the CRT-to-Registry admission pathway, a different thing (NBRC notice).
NBRC lists a minimum age of 18. Its dedicated RT admission list and application include these routes (NBRC RT page, 2027 RT application):
- Graduation from, and at least an associate degree from, an entry-into-practice respiratory therapy program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC).
- The Canadian Society of Respiratory Therapists (CSRT) RRT credential.
A score below the RT low cut does not cancel an existing CRT. NBRC says a CRT who scores below the low cut keeps the CRT and can retake the exam to try for the RRT.
Your state license is separate. State boards decide who may practice. NBRC's exams can serve state licensing, but you apply through your state's own process, and legal licensing questions go to the state agency (Handbook p. 7). For the full education-to-license path, see our guide to respiratory therapist certification and state licensing.
Do old attempts count on the new exam?
No. NBRC says attempts on the TMC and CSE don't count toward the RT Exam (NBRC RT FAQ). On the RT Exam you get three attempts, then at least 120 days between each later attempt. Ordinary retakes require a new application and fee, and you still need to be eligible. For worked date examples and missed-appointment rules, see NBRC retake waits and application rules.
Which outline should you study?
Use the outline for the exam you'll actually sit, not your graduation year.
| The exam you'll take | Official outline |
|---|---|
| TMC, through December 31, 2026 | TMC Detailed Content Outline, effective January 2020 |
| CSE, as an eligible transition candidate (including in 2027) | CSE Detailed Content Outline, effective January 2020 |
| RT Examination | RT Detailed Content Outline, effective January 2027 |
What's inside the new RT outline
Each RT Exam form has 160 scored items in two portions, assembled into one exam (RT outline, pp. 1–2, 11, 15, 22–24):
- Breadth of Knowledge — 100 items, built on the same three broad content areas as the TMC.
- Depth of Clinical Judgment — 60 items. This is where the CSE's skills now live. They're standalone multiple-choice items organized by patient type, setting, patient age, and whether you're gathering information or making a decision.
| Content area | TMC (scored items per form) | RT Examination (scored items per form) |
|---|---|---|
| Patient Data | 50 | 25 |
| Devices and safety* | 20 | 25 |
| Initiation and Modification of Interventions | 70 | 50 |
| Depth of Clinical Judgment | No separately named Depth portion | 60 |
| Total scored | 140 | 160 |
*TMC: Troubleshooting and Quality Control of Devices, and Infection Control. RT: Management of Devices and Patient Safety Procedures.
Don't read the smaller Patient Data number as "patient data matters less." Depth items also link to the tasks in the Breadth portion, including interpreting patient data and choosing interventions.
The 60 Depth items on every form:
| Specification | Items per form |
|---|---|
| Adults | 50 — chronic lung disease 17, medical 15 (infectious disease, ARDS, other such as obesity or drug toxicity), cardiovascular 5, pre-/post-operative 5, trauma 4, neurological/neuromuscular 4 |
| Children | 10 — neonatal 6 (resuscitation, respiratory distress syndrome), pediatric 4 |
| Type of judgment | Decide what to add, change, continue, or stop: 40. Choose what to assess or interpret: 20 |
| Setting | In a hospital 46, outside a hospital 14 |
These are overlapping descriptions of the same 60 scored Depth items, not additional sets of questions.
Across the whole exam, every form has 15 to 18 neonatal or pediatric scored items. Chronic lung disease alone is 17 Depth items, split across invasive ventilation, noninvasive management, outpatient management, and evaluating a new diagnosis.
Topics the 2027 outline names that the TMC outline didn't
We checked these named topics against both official outlines. These appear by name in the 2027 RT outline but not in the 2020 TMC outline:
- Medications: antifibrinolytics, biologics for asthma (dupilumab is the named example), and CFTR modulators for cystic fibrosis (elexacaftor/tezacaftor/ivacaftor is the named example)
- History and education: vaping history and vaping cessation, social determinants of health
- Communication: patient-centered, trauma-informed, and culturally aware interaction with patients and families
Ethics remains in scope. It was already in the TMC outline. The RT outline requires at least 5 ethics-linked Breadth items and 3 ethics-linked Depth items per minipool (a single form isn't guaranteed to include one). (RT outline, pp. 22–23, TMC outline, p. 12)
Sources for the named-topic comparison: RT outline, pp. 4–5, 17, 19, 22 and TMC outline, pp. 1–13.
Named in the outline doesn't mean heavily tested. Treat these as gaps to close, not as the center of your plan.
What a Depth of Clinical Judgment item can look like
"How do you test simulation skills with multiple choice?" A scenario with enough data for one best decision. The four items below are original Castleport practice items written to the 2027 outline's Depth categories. They are not NBRC questions and they don't predict your score. They illustrate selected topics, not the full blueprint or a validated simulation of exam difficulty. Use them for exam preparation, not patient-care decisions.
In the examples, COPD means chronic obstructive pulmonary disease; NIV means noninvasive ventilation; CPAP means continuous positive airway pressure; ARDS means acute respiratory distress syndrome; PBW means predicted body weight.
Question 1 — Adult chronic lung disease · noninvasive management · decision making · in hospital
A 68-year-old man with COPD comes to the emergency department after two days of worsening dyspnea. He is alert, follows commands, is protecting his airway, and is hemodynamically stable. He has no vomiting or copious secretions. Despite initial standard medical therapy, his findings on 2 L/min nasal cannula are pH 7.30, PaCO2 66 mm Hg, and PaO2 62 mm Hg. Respiratory rate is 30/min with accessory muscle use. What should the respiratory therapist recommend?
Reveal answer
Answer: B. The low pH and high PaCO2 show hypercapnic respiratory acidosis. The ERS/ATS guideline strongly recommends bilevel NIV for COPD exacerbations with acute or acute-on-chronic respiratory acidosis (pH ≤ 7.35). The supplied findings support a monitored trial of bilevel NIV, with prompt intubation available if he deteriorates or fails to improve.
- A increases oxygen delivery but does not correct inadequate ventilation. Waiting an hour would delay needed ventilatory support.
- C CPAP alone adds no inspiratory pressure support. The guideline recommendation is bilevel NIV.
- D The guideline recommends a trial of bilevel NIV even when intubation is being considered, unless the patient is immediately deteriorating. He isn't.
Outline mapping: NBRC RT Detailed Content Outline, p. 23 (Chronic Lung Disease — noninvasive management); p. 24 (decision making and hospital setting)
Question 2 — Adult medical (ARDS) · invasive ventilation · decision making · in hospital
A 45-year-old man intubated for ARDS is 178 cm (5 ft 10 in) tall and weighs 110 kg. The team orders lung-protective ventilation starting at 6 mL/kg of predicted body weight. Which initial tidal volume is closest to that order?
Reveal answer
Answer: B. Predicted body weight for a male = 50 + 0.91 × (height in cm − 152.4) = 50 + 0.91 × 25.6 ≈ 73.3 kg. At 6 mL/kg: 73.3 × 6 ≈ 440 mL.
- A is about 4.5 mL/kg PBW — below the ordered starting point.
- C is 6 mL/kg of actual body weight. The predicted-body-weight formula uses height and sex, not actual weight — that's the trap.
- D is 8 mL/kg of actual weight, about 12 mL/kg PBW.
Once the volume is set, the lung-protective goal is a plateau pressure below 30 cm H2O.
Sources: Surviving Sepsis Campaign 2008, Appendix E, printed p. 46 / PDF page 30 — predicted body weight formula; ATS 2024 ARDS guideline, Overview, printed p. 25 / PDF page 3 — lung-protective ventilation
Outline mapping: NBRC RT Detailed Content Outline, p. 23 (Medical — ARDS); p. 24 (decision making and hospital setting)
Question 3 — Neonatal · resuscitation · decision making · in hospital
A term newborn (39 weeks) is still apneic after warming, drying, positioning the airway, and stimulation. Heart rate is 80/min. What should be done next?
Reveal answer
Answer: B. After the initial steps, a newborn who is apneic, gasping, or has a heart rate below 100/min needs positive-pressure ventilation without delay. For this 39-week newborn, begin with air (21% oxygen), then titrate oxygen using pulse-oximetry targets.
- A Compressions are for a heart rate below 60/min despite 30 seconds of adequate ventilation. Ventilation comes first.
- C Blow-by oxygen does not provide ventilation for an apneic newborn.
- D Right action, wrong starting oxygen for a term baby.
Source: 2025 AHA/AAP Neonatal Resuscitation guideline, §§11.1, 12, 13.1 and Epinephrine overview
Outline mapping: NBRC RT Detailed Content Outline, p. 23 (Neonatal — resuscitation); p. 24 (decision making and hospital setting)
Question 4 — Neonatal · resuscitation · decision making · in hospital
A 39-week newborn remains apneic during resuscitation. The team has optimized ventilation and confirmed endotracheal tube placement. After 30 seconds of positive-pressure ventilation that produces chest movement, heart rate remains 50/min. What is the next step?
Reveal answer
Answer: B. Heart rate remains below 60/min despite 30 seconds of ventilation that inflates the lungs, so begin chest compressions coordinated with ventilation. Chest movement shows lung inflation; a rising heart rate is the key response to ventilation.
- A Waiting another minute ignores a heart rate that has already crossed the compression threshold.
- C Epinephrine is indicated only if the heart rate stays below 60/min despite 60 seconds of chest compressions with adequate ventilation. It doesn't come first.
- D CPAP supports a baby who is breathing. This baby needs ventilation plus compressions.
Source: 2025 AHA/AAP Neonatal Resuscitation guideline, §§11.1, 12, 13.1 and Epinephrine overview
Outline mapping: NBRC RT Detailed Content Outline, p. 23 (Neonatal — resuscitation); p. 24 (decision making and hospital setting)
How to update your prep
- Name your exam. Write TMC, CSE, or RT at the top of your study plan, based on the table at the top of this page.
- Match your notes to that exam's dated outline. Older review books and notes still teach real respiratory care, but a title or year doesn't prove they cover the 2027 outline. Mark the gaps.
- Train decisions, not just recall. Two-thirds of Depth items ask what you'd add, change, continue, or stop. For every case you review, say the decision and the reason.
- Give neonatal/pediatric and out-of-hospital care real time. Every form has 15 to 18 neonatal or pediatric scored items, and 14 Depth items are set outside a hospital.
- Close the named-topic gaps: asthma biologics, CFTR modulators, antifibrinolytics, vaping, trauma-informed and culturally aware communication, and ethics.
- Use NBRC's own practice tools for format. The RT page links a free RT practice exam. NBRC says it uses the same testing software and must be finished in one sitting to get results. Still taking the TMC or CSE? See TMC preparation for testing through December 2026 or CSE practice for eligible transition candidates.
More questions
Will the new exam be easier? NBRC says it intends to keep CRT and RRT standards where they are — not easier, not harder (NBRC announcement). That's a stated intent, not a pass-rate prediction. The real change for CRT candidates: the new exam includes 60 scored Depth items for everyone; under the TMC route, CRT candidates did not take the CSE.
Are the specialty exams (ACCS, NPS, SDS, PFT, AE-C) changing? The 2027 change covers the CRT/RRT exam system. NBRC lists the specialty and pulmonary function exams separately; check each examination's own current outline and requirements (NBRC examinations list).
When do I get my score? Score reports are emailed to the address on file with PSI, NBRC's testing agency. If yours doesn't arrive within 24 hours, contact PSI (Handbook p. 12). For what the report means, see NBRC exam results.
How do I request testing accommodations? Send NBRC its accommodations request form and disability-documentation form. If you haven't received NBRC accommodations before, submit the request before you apply and pay, or approved accommodations won't be in place for your scheduled exam (Handbook p. 3).
Official sources and your next step
- Clear route? Review your requirements and apply through the NBRC Practitioner Portal. Checking TMC eligibility first? See TMC eligibility and application requirements.
- Unsure about the TMC application cutoff, a CRT-to-Registry record, an old eligibility record, or switching from CSE to RT? Contact NBRC before you apply: info@nbrc.org or apply@nbrc.org, 913-895-4900.
Sources checked October 30, 2026:
- NBRC — Respiratory Therapy (RT) Examination and FAQs
- NBRC — Resources and RT Examination FAQs
- NBRC — Examination Changes Coming in 2027 – New Details Added
- NBRC — Examinations list
- NBRC — TMC (CRT) examination page and CSE examination page
- NBRC — Candidate Handbook, rev. September 3, 2026
- NBRC — RT Detailed Content Outline, effective January 2027, TMC Detailed Content Outline, CSE Detailed Content Outline
- NBRC — 2027 RT Exam application (PDF)
- NBRC — CRT-to-Registry Admission Policy Expires in December 2026
- NBRC — Accuracy of a Testing Result, Part 1, p. 3, Table 1 — RT cut scores
- NBRC — Repeat attempt policy
- Indiana Professional Licensing Agency — Respiratory Care announcements (NBRC transition notice, Sept. 10, 2026)
- Practice-item sources: ERS/ATS NIV guideline, Surviving Sepsis Campaign 2008, Appendix E — PBW formula, ATS 2024 ARDS guideline, 2025 AHA/AAP neonatal resuscitation guideline
Last verified: October 30, 2026 — NBRC exam formats, transition dates, fees, eligibility notices, retake rules, cut scores, and content outlines, plus the clinical sources and worked calculation for the four practice examples. This is a source check, not a test of NBRC's application or practice systems. NBRC can change its rules; check the RT page before you apply.
AI-assisted tools helped prepare and check this page. Our editorial methodology explains how source checking differs from professional clinical review.
Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by the National Board for Respiratory Care. Exam and credential names identify the subjects discussed; trademarks belong to their respective owners. The practice items on this page are original and are not official NBRC exam questions.