NBRC NPS Exam Prep

A free study guide for RRTs taking the NBRC Neonatal/Pediatric Specialty (NPS) exam, built on the content outline effective October 1, 2025.

24 practice questions

They are unofficial Castleport practice, not NBRC questions, not a full-length exam, and not a prediction of your result. Pick an answer, then reveal the explanation.

Jump to the outline map or six-week study plan, or continue with Question 2.

These 24 original questions cover selected concepts from both sections of the outline, weighted toward ventilation, specialty gases, and the delivery room.

Review your misses by outline area: Questions 1–6 cover ventilation and oxygenation (II-C); 7–10 specialty gases (II-B); 11–13 surfactant, extubation, and end-of-life care (II-E, II-D, II-F); 14–18 resuscitation (I-J); 19–21 airway management (I-D); 22 blood gas sampling (I-F); 23–24 bronchiolitis medications and oxygen (I-G, I-H). Your score here reflects these 24 items only. A handful of questions per area isn't enough to measure that area; use misses to choose what to study next.

Turn misses into your next study session

A missed question is only useful if you can say why you missed it. Keep a short log like this one, on paper or in a spreadsheet:

Retry missed items a few days later without looking at the explanation. If you get it right but can't explain why, count it as a miss.

Where the 150 scored questions come from

NBRC's NPS Detailed Content Outline lists exactly how many scored questions each content area gets on every exam form. That's the most useful planning fact you have, so here it is sorted by size.

Shares are each count divided by 150, rounded.

What this tells you:

1. Ventilation and oxygenation is the biggest block. One in five scored questions comes from II-C, and every one of those 30 is an application or analysis question, not recall.
2. The exam is mostly judgment. 128 of the 150 scored questions are integration-level, meaning you apply facts to a case or pick the best action from a set of findings. Only 22 are pure recall.
3. The dedicated I-J resuscitation subdomain has 3 scored questions. Related airway, ventilation, medication, and procedure concepts also appear elsewhere. Know neonatal and pediatric resuscitation well, but don't neglect ventilator management.

The outline also requires at least 86 scored questions per form tied to pulmonary disorders and at least 34 tied to non-pulmonary disorders. Its disease list includes neonatal pulmonary conditions (meconium aspiration, pneumonia, PPHN), asthma, chronic lung disease of prematurity, infections such as croup and pneumonia, acute prematurity problems (surfactant deficiency, apnea), bronchiolitis, and pediatric ARDS. Use those names as a coverage checklist. The disease-specific item-pool minimums are not question counts for your delivered exam or a formula for study hours.

Use the right outline. NBRC also publishes a separate NPS Credential Maintenance Program outline for people who already hold the credential. If you're earning the NPS, study from the credentialing outline above.

The math you'll do on test day

NBRC builds an on-screen calculator into the exam software, so you won't bring your own, but you do need the formulas.

Pediatric ARDS severity (PALICC-2, Table 4), invasively ventilated children with established PARDS: classify at least 4 hours after diagnosis using steady-state measurements. OI under 16 or OSI under 12 is mild/moderate; OI 16 or more or OSI 12 or more is severe. These thresholds do not by themselves diagnose PARDS. The standard OI/OSI severity categories do not apply to children with cyanotic congenital heart disease or chronic lung disease requiring invasive ventilation at baseline.

The OI and OSI equations use FiO2 as a fraction and SpO2 as the percentage number: enter 90, not 0.90, for SpO2 of 90%.

Why OI isn't just the P/F ratio. Two children can have the same oxygen result on the same FiO2 and still be very different, because OI also counts how much pressure it takes to get there.

Same P/F ratio, double the OI, because Child B needs twice the mean airway pressure. That's the whole point of the index.

Two input traps. Use FiO2 as a fraction (0.80, not 80) or your answer will be off by a factor of 100. And OI needs an arterial PaO2: the AARC guideline on capillary blood gas sampling finds that arterialized capillary samples underestimate PO2, while capillary pH and PCO2 can be acceptable. If an arterial PaO2 is unavailable, OSI can be used when its clinical conditions are met and a reliable steady-state SpO2 is no higher than 97%.

High-yield numbers from the cited guidelines

Each line is tied to the source that sets it.

• Delivery room oxygen (2025 AHA/AAP neonatal): For newborns receiving respiratory support at birth, the suggested starting concentrations are 21% at 35 weeks or more; 21% to 30% at 32 to 34 6/7 weeks; and 30% to 100% under 32 weeks. Titrate with a preductal oximeter on the right hand or wrist.
• Neonatal heart rate triggers (2025 AHA/AAP): start ventilation within 60 seconds if apneic or gasping, or if heart rate stays under 100/min after initial steps. Start compressions if under 60/min after 30 seconds of ventilation that moves the chest. Give epinephrine if still under 60/min after 60 seconds of compressions with adequate ventilation.
• Neonatal compressions (2025 AHA/AAP): 3:1 ratio, two-thumb encircling technique, about one third of the chest's front-to-back depth.
• Neonatal epinephrine (2025 AHA/AAP): Intravascular 0.01–0.03 mg/kg plus a 3 mL saline flush; endotracheal 0.05–0.1 mg/kg only while getting vascular access; repeat every 3–5 minutes if heart rate remains below 60/min.
• Laryngeal mask in newborns (2025 AHA/AAP): recommendations apply at 34 weeks or more.
• Meconium (2025 AHA/AAP): no routine suctioning, clear or meconium-stained; suction only for obstruction.
• Rescue breathing, infant or child with a pulse (2025 AHA/AAP pediatric BLS): 1 breath every 2–3 seconds (20–30/min).
• Inhaled nitric oxide (labeling): 20 ppm for term and near-term (over 34 weeks) neonates with hypoxic respiratory failure and pulmonary hypertension; methemoglobin within 4–8 hours of starting and periodically; monitor PaO2 and inspired NO2. An unexpected NO2 change or circuit level reaching 3 ppm calls for system troubleshooting, analyzer recalibration, and INOmax-dose and/or FiO2 adjustment as appropriate. Wean in steps; contraindicated when the neonate depends on right-to-left shunting.
• Surfactant (Curosurf labeling): oxygenation and compliance can change rapidly after a dose; reassess often and adjust support.
• Pediatric ARDS severity (PALICC-2): OI 16 or OSI 12 marks severe in invasively ventilated children with established PARDS, subject to the timing, population, and measurement conditions above.
• Suctioning (AARC 2022): as needed, not on a schedule; avoid routine saline instillation.
• Uncomplicated bronchiolitis (2014 AAP guideline): routine albuterol, epinephrine, and systemic steroids are not recommended. Clinicians may choose to withhold oxygen above SpO2 90% in the applicable population; see Q23–Q24 for the relevant conditions.
• HFOV (NHS GGC neonatal guideline, UK): MAP and FiO2 primarily govern oxygenation. Without volume guarantee, amplitude is adjusted for CO2 clearance; frequency changes can also markedly change ventilation. Assess lung inflation, blood gases and perfusion together. The cited guide uses the 8th–9th posterior ribs as an inflation guide, not a universal standalone target.

Your 6-week NPS study plan

This assumes you're a working RRT with about 6 to 8 study hours a week, and it follows the outline's weight, heaviest areas first. It's a way to organize your review, not an official requirement or a guarantee that six weeks is enough for you. Every session should mix three things: a few minutes recalling last session's material without notes, focused study, and practice questions or case work.

Adjusting it:

• Four weeks: combine original weeks 1 and 2 for your first week; use original week 3 for your second; combine original weeks 4 and 5 for your third; finish with original week 6. Allow about 9 to 12 hours a week on average, with more time in the combined weeks.
• Eight weeks or more: give weeks 1 and 2 extra time, since that's where 35 of the 150 scored questions sit (II-C and II-B).
• Little NICU or PICU experience: add sessions for the patient groups you rarely see, and use your week 1 outline checklist and error log to decide where.

Pace check: 4 hours for 170 questions is about 1 minute 25 seconds each on average. Breaks are allowed, but the clock keeps running. There's no guessing penalty, so answer everything.

NPS exam facts you need before you book

The exam right now: 170 multiple-choice questions (150 scored, 20 unscored pretest) · 4 hours · $250 first attempt, $220 repeat · open only to Registered Respiratory Therapists (RRTs). Last verified October 29, 2026: NBRC's NPS page, the October 2025 outline, the Candidate Handbook (rev. 09/03/2026), and the clinical sources cited below.

Who can take it. You must be an RRT. The current NPS admission policy has no added experience requirement, so you can apply once you've earned the RRT. If you're still working toward it, see our guide to CRT and RRT certification. The new Respiratory Therapy Examination becomes available January 4, 2027 and awards RRT at its high cut score; qualifying candidates can still complete the CSE through December 31, 2027. The current NPS admission requirement remains RRT.

Format. 170 multiple-choice questions: 150 scored and 20 unscored pretest items mixed in so you can't tell which is which. You get 4 hours. Questions appear one at a time with options A through D, and you can bookmark, skip, and come back.

Scoring. Each scored question is worth one point. Your raw score is compared with a cut score that NBRC sets through a standard-setting study with subject-matter experts. NBRC’s published scoring guidance lists an NPS cut score of 96 correct scored answers. Your official score report determines your result. The Candidate Handbook says your score report is emailed after the exam, and to contact PSI if it hasn't arrived within 24 hours. More on reading it: NBRC exam results.

Cost. $250 for a first attempt and $220 for a repeat. AARC members can get a one-time $40 discount on their first NPS application, but only by registering through AARC first and starting the NBRC application from the link AARC emails.

Scheduling. Apply through NBRC. Once your application is accepted, you have 90 calendar days to test at a PSI assessment center, Monday through Saturday except listed holidays and subject to appointment availability. You can reschedule once in that window if you contact PSI at least one business day ahead. Report at your scheduled appointment time; arrive more than 15 minutes late and you won't be tested or refunded. Bring two current IDs bearing your current name and signature; one must be an accepted photo ID. Temporary IDs are not accepted. Check the handbook’s ID requirements before test day.

Accommodations. If you need testing accommodations and haven't had them for an NBRC exam before, NBRC requires the request form before you apply and pay. If it arrives after you've paid and scheduled, approved accommodations won't apply to that appointment.

Retakes. You can take the NPS twice without a waiting period. After that, you must wait at least 180 days before each later attempt, and every attempt needs a new application and fee. Details: NBRC exam retake policy.

Keeping it. A new NPS credential has a five-year term under the Credential Maintenance Program. Options include quarterly assessments and/or the required continuing education; retaking and passing the highest credentialing examination you hold that is subject to CMP, in the final year of the cycle; or passing an NBRC credentialing examination you have not previously completed. Check NBRC’s CMP guidance for the route that applies to your credentials.

Official free NPS practice

• Free NPS practice exam: available from NBRC's NPS page, using the same software as the real test. You enter an email address for your results and must finish in one sitting. Use it for optional software familiarization and additional practice.

The official practice questions are copyrighted NBRC material. Don't copy or share their questions; NBRC treats that as misconduct that can cost you your credential.

Common questions

How hard is the NPS exam? It's a specialty exam for practicing RRTs, and 85% of scored questions ask you to apply or analyze rather than recall. NBRC publishes first-time and repeat pass rates for every exam in its annual Examinations in Review sheet.

Should I take the NPS right after earning my RRT? You're eligible as soon as you're an RRT. Whether it's smart depends on your neonatal and pediatric exposure. If you've had little NICU or PICU time, use the outline checklist and the explanations you cannot yet give to choose your review topics. These 24 questions cannot determine whether you are ready to pass.

Is the NPS a license? No. It's a voluntary national specialty credential. State respiratory care licensure is separate and handled by each state's licensing agency.

Do prep materials built on older outlines still work? They can still teach the clinical content, but check them against the outline effective October 1, 2025, especially for exam length (170 questions in 4 hours) and topic coverage. Check clinical recommendations against their own dated sources, such as the 2025 neonatal resuscitation guidelines. The outline identifies tested subjects; it does not establish when NBRC adopted each guideline update.

Sources

Exam documents, clinical sources, and drug labels below checked October 29, 2026.

Exam facts

• NBRC, Neonatal/Pediatric Specialty (NPS) exam page: eligibility, fees, format, AARC discount, retake table, free practice exam

• NBRC, NPS Detailed Content Outline, effective October 1, 2025: section and subsection counts, cognitive levels, patient-type specifications (pp. 1–15)

• NBRC, Content outlines: credentialing vs Credential Maintenance Program outlines

• NBRC, Candidate Handbook, rev. 09/03/2026: pretest items, timing, scoring, scheduling, ID, accommodations, retakes, Credential Maintenance Program, 2027 RT Examination

• NBRC, 2025 Examinations in Review: annual pass rates by exam

• NBRC, Accuracy of a Testing Result, Part 1: Table 1, printed p. 3, NPS cut score

• NBRC, Resources: 2027 examination transition and Credential Maintenance Program

Clinical content

• American Heart Association and American Academy of Pediatrics, Part 5: Neonatal Resuscitation, 2025 Guidelines (Circulation, October 2025)

• American Heart Association and American Academy of Pediatrics, Pediatric Basic Life Support, 2025 Guidelines, section 6.2

• Emeriaud G, et al. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric ARDS (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143–168.

• Abu-Sultaneh S, et al. International Clinical Practice Guidelines for Pediatric Ventilator Liberation (PALISI). Am J Respir Crit Care Med. 2023;207(1):17–28.

• INOmax (nitric oxide) prescribing information, revised 4/2023, DailyMed

• Curosurf (poractant alfa) prescribing information, revised 5/2022, DailyMed

• Blakeman TC, et al. AARC Clinical Practice Guidelines: Artificial Airway Suctioning. Respir Care. 2022;67(2):258–271.

• Evans DL, et al. AARC Clinical Practice Guidelines: Capillary Blood Gas Sampling for Neonatal and Pediatric Patients. Respir Care. 2022;67(9):1190–1204.

• Ralston SL, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014;134(5):e1474–e1502.

• NHS Greater Glasgow and Clyde, High Frequency Oscillatory Ventilation (HFOV): a guide to the use of HFOV in the neonate (UK institutional guideline, reviewed October 25, 2024)

• UC Davis Children's Hospital, Congenital Diaphragmatic Hernia clinical management guidelines

• WHO Regional Office for Europe, Palliative care for children (June 2023)

• Muniraman HK, et al. Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure. JAMA Network Open. 2019;2(3):e191179. Introduction: OI and OSI formulas.

• Children’s Wisconsin, Bronchiolitis clinical guideline (revised October 2, 2026): oxygen monitoring and adjunct therapies, pp. 7–8. Institutional guidance.

About this page. Written by the Castleport Test Prep Editorial Team. We checked the exam facts against NBRC's current published documents and the practice-question explanations against the clinical guidelines and drug labeling listed above. This is exam preparation, not clinical direction; current guidelines and your hospital's protocols govern patient care.

Independence. 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 (NBRC). Exam and credential names identify their subjects; trademarks belong to their respective owners. All practice questions on this page are original and unofficial.