Castleport Test Prep

Respiratory Therapist Certification: CRT, RRT, and the 2027 NBRC Exam

In the U.S., respiratory therapist certification means earning the Certified Respiratory Therapist (CRT) or Registered Respiratory Therapist (RRT) credential from the National Board for Respiratory Care (NBRC). Your state license is a separate step; the new NBRC exam takes effect January 1, 2027, with testing starting January 4, 2027, so find your starting point below.

Find your route

Your starting point Your route and next step
You haven't finished respiratory therapy school Enroll in a program listed as Entry into the Profession by the Commission on Accreditation for Respiratory Care (CoARC). You'll need at least an associate degree from it. An unrelated degree or an exam-prep certificate doesn't qualify you.
You're a graduate testing in 2026 Take the Therapist Multiple-Choice (TMC) Exam ($190). Confirm the final application cutoff with NBRC before you pay. Test by December 31, 2026. The low cut earns CRT. The high cut earns CRT and opens the Clinical Simulation Exam (CSE), subject to its admission requirements.
You're a graduate testing in 2027 or later Take the Respiratory Therapy (RT) Exam ($360). Applications are open now, and testing starts January 4, 2027. The low cut earns CRT. The high cut earns RRT directly.
You hit the TMC high cut by Dec 31, 2026 but haven't passed the CSE If you meet the applicable admission requirements, pass the CSE ($200) by December 31, 2027, or take the RT Exam and reach its high cut. An RT application ends eligibility to apply for CSE under the NBRC transition notice below.
You're a CRT with a qualifying associate degree or higher from a CoARC program To move up to RRT from 2027, reach the high cut on the RT Exam, or use the CSE transition route above if eligible. Scoring below the low cut doesn't cost you your CRT.
You're a CRT relying on legacy CRT-to-Registry eligibility That admission route ends December 31, 2026. Your CRT alone will not qualify you for the new RT Exam. Ask NBRC now which route your record still allows before you pay.
You already hold the RRT The exam change does not require you to retake an exam. Keep your NBRC credential and your state license current.
You trained outside the U.S. or hold the Canadian (CSRT) RRT Foreign education alone does not establish eligibility for the standard U.S. graduate route. NBRC lists a separate CSRT RRT admission route. Contact NBRC about the application and documentation required for your examination.

Sources: NBRC RT Exam page and FAQs, NBRC Resources FAQs, NBRC CSE page, and RT application effective January 1, 2027. By Castleport Test Prep Editorial Team. NBRC routes, dates, and fees last verified October 29, 2026.

Before choosing the RT Exam instead of the CSE: a September 2026 NBRC transition notice published by Indiana's licensing agency states that once you apply for the RT Exam, you are no longer eligible to apply for the CSE. Confirm your choice with NBRC before switching if you want to preserve the CSE option. (Indiana Professional Licensing Agency, September 10 announcement)

What you need to qualify

For a standard first-time applicant, NBRC requires two things. You must be 18 or older. You must also have graduated from a CoARC-supported or accredited entry-into-practice respiratory therapy program with at least an associate degree. A bachelor's degree is not required, and an associate degree in another field doesn't count. (NBRC RT Exam admission requirements)

Check the program category before you enroll. CoARC's directory sorts programs into categories, and they serve different people:

Each listing also shows the program's accreditation status. Open the record before you commit. (CoARC program finder)

How long it takes. NBRC describes entry-into-practice programs as typically two years to graduation. Prerequisites, your program's calendar, and how long your state takes to process a license can all add time. Ask the program for its actual schedule from prerequisites to graduation. (NBRC RT Exam FAQs)

CRT vs RRT and the three NBRC exams

Both credentials come from NBRC. From 2027, the difference is how high you score on the RT Exam.

  • Through 2026: The TMC high cut doesn't earn RRT by itself. It opens the CSE for eligible candidates, and passing the CSE earns RRT.
  • From 2027: One exam does both jobs. A cut score is the passing line for each credential, and the RT Exam's high cut awards RRT directly.
Exam Status Format Time First attempt Repeat
TMC Ends Dec 31, 2026 160 multiple-choice (140 scored, 20 pretest) 3 hours $190 $150
CSE Restricted transition route; ends Dec 31, 2027 22 simulation problems (20 scored, 2 pretest) 4 hours $200 $200
RT Exam Starts Jan 4, 2027 185 multiple-choice (160 scored, 25 pretest) 4 hours $360 $300

Pretest items aren't scored, and you can't tell which ones they are. Sources: NBRC TMC page, NBRC CSE page, NBRC RT Exam page, NBRC Resources FAQs.

Aim for the high cut. On the new RT route there's no separate "RRT exam" to sit later. NBRC also says the new exam isn't meant to be easier or harder than before. The new overall CRT passing standard includes clinical-judgment questions. (NBRC: Examination Changes Coming in 2027)

Should you take the TMC before it ends?

Only if you're ready now. Both routes lead to the same two credentials.

Test on the TMC in 2026 if you've finished your program, your practice scores are solid, and a job or license needs a credential soon. A pass earns CRT now, and a high-cut pass can keep the CSE open through 2027 if you meet its admission requirements and preserve that option.

Wait for the RT Exam if you'd be cramming. If you fail the TMC in December, there's no TMC retake in 2027. Your next attempt would be the longer RT Exam. On the plus side, earlier TMC and CSE attempts don't count toward your first three RT Exam attempts.

Check the application deadline before committing. NBRC currently publishes two final TMC application dates: December 15 on its RT Exam page and December 17 on its Resources page. Confirm the cutoff with NBRC; an application deadline does not guarantee a testing appointment. The last TMC testing day is December 31, 2026. (NBRC RT Exam FAQs, NBRC Resources FAQs)

If you've hit the TMC high cut, keep your eligibility record active. NBRC's handbook describes inactivation after a year without an examination appointment or an indication that you intend to test. Its TMC FAQ warns that inactivation can nullify a passing result toward an unfinished RRT credential. Check your record with NBRC if you've delayed. The CSE also ends December 31, 2027. (NBRC Candidate Handbook, Inactive Eligibility Records, NBRC TMC FAQs, record retention)

If your record involves the pre-2015 Written Registry Examination or a legacy CRT-to-Registry route, have NBRC confirm your remaining CSE eligibility before paying. The current CSE page still lists historical admission routes; that does not establish that every legacy record continues into 2027. (NBRC CSE admission requirements and FAQs)

Retakes: You get three attempts at each exam (TMC, CSE, or RT Exam). After that, you wait at least 120 days between attempts. That's a waiting period, not a lifetime limit. (NBRC RT Exam FAQs)

Is certification the same as a license?

No. NBRC certifies you. Your state licenses you to practice, and the board uses your NBRC credential as part of that decision. Earning CRT or RRT doesn't complete your license application.

State requirements and exceptions differ. These selected examples show why your NBRC route and your state application need separate checks; this is not a complete state-by-state licensing list.

State Current requirement or scheduled change Official source
Ohio RRT-level examination results for the standard initial route. Existing Ohio licensees admitted through CRT may renew; reciprocity is a separate route. OAC 4761-5-01
California RRT-level examinations for the standard route, with a statutory exception for specified CRT or Written Registry examinations passed before Jan 1, 2015. BPC §3735
Arizona RRT is required for new applicants. CRT holders with an active Arizona license since before 2017 may continue renewing. Arizona Board, Application for Licensure and RRT Required notice
Oregon Active RRT. Those licensed before Jan 1, 2018 using CRT are exempt from the RRT requirement. OAR 331-710-0010(6), (8)
New Mexico RRT for the standard route. CRT is accepted if the applicant was licensed in New Mexico or another U.S. jurisdiction before Jan 1, 2018. Board FAQ, 16.23.3 NMAC
Georgia Active RRT, active CRT issued before Mar 15, 2020, or active CRTT issued before July 1, 1999. Georgia calls its state authorization Board certification. Rule 360-13-.01(4)
Washington For the standard examination route, licenses issued from July 1, 2022 require approved written and clinical simulation examinations. An active RRT meeting the law's examination requirements can establish compliance. RCW 18.89.090
West Virginia CRT or RRT. The rule effective May 1, 2025 removed the former date-based distinctions. Series 1, §30-1-3, board update
Missouri Active RRT or an active CRT earned before Jan 1, 2027, among the statutory routes. That is the CRT earning cutoff; the law is already effective. RSMo §334.870
Indiana An approved licensing or certification examination passed before Jan 1, 2028 remains an alternative. For examinations completed after Dec 31, 2027, the law requires both portions of the RRT examination or its successor. HEA 1254 §6, pp. 4–5 (enrolled-text copy)

New Jersey law accepts either the RRT or CRT examination for its examination requirement. Other licensure requirements still apply. (P.L. 2023, Chapter 176)

Example: California. On the standard route, you need the RRT. The statutory examination exception covers the CRT Examination or Written Registry Examination passed before January 1, 2015, subject to the board's findings about prior license- or job-related discipline. You also need a CoARC-accredited program with at least an associate degree, plus a board-approved law and ethics course; the board may approve limited education waivers. The board states plainly that an NBRC credential alone doesn't let you practice in California. (Respiratory Care Board of California)

Alaska enacted a respiratory-care licensing law in 2026. Its statutes take effect January 1, 2027, with a transition for existing practitioners until January 1, 2028. The state says licensure will be required from January 1, 2028, subject to the law's exceptions; applications cannot open until regulations take effect. (Alaska Respiratory Care Practitioners program, proposed-regulations FAQ, questions 4 and 7)

Find your state licensing agency through NBRC.

How much does it cost?

Cost Amount
RT Exam (from Jan 4, 2027) $360 first attempt · $300 repeat
TMC (through Dec 31, 2026) $190 first attempt · $150 repeat
CSE (eligible candidates, through Dec 31, 2027) $200
NBRC Credential Maintenance Program, assessment/CE route $25 annually before payment year 2027; $30 annually from 2027 ($150 over five years at that rate)
Education Your program's published tuition and fees
State license Set by each state

On the old route, first attempts at both exams cost $390 ($190 + $200). The RT Exam alone is $360. If you've already paid for and passed the TMC, your next CSE attempt is $200. Sources: NBRC Resources FAQs, NBRC RT Exam FAQs, and CMP brochure, Program Fees.

Can you get certified online?

Partly. Some programs teach coursework online, and you apply to NBRC online. But your program still requires hands-on lab and clinical training, and the exam itself is in person. NBRC ended live remote proctoring on December 31, 2024. Since January 1, 2025, every NBRC exam is taken at a PSI testing center. (NBRC announcement, NBRC Resources FAQs, CoARC Entry Standards, Standard 1.03 and Distance Education)

Before you sign up for an online program, ask:

  • Is it an entry program or a degree-advancement program?
  • What degree does it award?
  • Where do labs and clinical rotations happen?

A course-completion certificate on its own doesn't meet NBRC's education requirement.

What happens on test day and after

  • Your pass/fail result appears on screen when you finish.
  • PSI emails your score report within 24 hours.
  • Your NBRC credential then becomes part of your state license application.

(NBRC Resources FAQs)

Your certification checklist

Fill this in before you pay for an exam or apply for a license.

Check What to confirm
New student, graduate, CRT, RRT, or a special admission route. Note any NBRC result and its date.
Program name and CoARC program number, Entry into the Profession category, degree, and current accreditation status.
Prerequisites, start and graduation dates, and where your clinical rotations happen.
TMC (by Dec 31, 2026), CSE (eligible transition candidates, by Dec 31, 2027), or RT Exam (from Jan 4, 2027). For any nonstandard route, get NBRC's confirmation in writing.
For the standard graduate route, confirm your school has submitted your graduation to NBRC. If this is your first NBRC accommodations request, submit the required form before applying and paying. Follow the Candidate Handbook for your request.
The state where you'll work, its licensing agency, whether it needs CRT or RRT, and any extra requirements.
Tuition, your next exam fee, the state application fee, and maintenance, each as its own line.
One concrete step: verify a program, apply to NBRC, schedule with PSI, or start your state application.

NBRC decides who can sit an exam. Your state board decides who gets a license.

Start studying: 6 original RT Exam-style questions

These are original, unofficial practice questions written by Castleport Test Prep. They cover selected topics in NBRC's January 2027 RT Exam outline, not its full scope or weighting. They are not real exam questions, and your result here doesn't predict your exam score. Use them for exam study, not patient-care instructions.

RTC-1 · Patient data: calculations

A patient at sea level (barometric pressure 760 mm Hg) is breathing room air (FiO2 0.21). ABG: PaO2 90 mm Hg, PaCO2 40 mm Hg. Using the simplified alveolar gas equation, 47 mm Hg for water vapor pressure, and a respiratory quotient of 0.8, what is the P(A–a)O2?

  • A. 0 mm Hg
  • B. 10 mm Hg
  • C. 50 mm Hg
  • D. 60 mm Hg
Reveal answer

B. About 10 mm Hg.

First find the alveolar PO2: (760 − 47) × 0.21 − 40 ÷ 0.8 = 149.7 − 50 = 99.7 mm Hg. Then subtract the measured PaO2: 99.7 − 90 ≈ 10.

  • D (60) comes from skipping the PaCO2 correction (149.7 − 90).
  • C (50) is just the PaCO2 ÷ RQ term.
  • A does not match the calculated difference between alveolar and arterial PO2.

Source: BTS, Guideline for oxygen use in adults in healthcare and emergency settings.

Outline mapping: Breadth I.C.7 / I.D.7 cardiopulmonary calculations

RTC-2 · Patient data: blood gas analysis

A postoperative patient received IV opioids and is now hard to arouse. ABG: pH 7.26, PaCO2 62 mm Hg, HCO3⁻ 27 mEq/L. Which interpretation fits best?

  • A. Acute respiratory acidosis
  • B. Chronic, compensated respiratory acidosis
  • C. Metabolic acidosis with respiratory compensation
  • D. Respiratory alkalosis with metabolic acidosis
Reveal answer

A. Acute respiratory acidosis.

The pH is low and the PaCO2 is high, so the primary problem is respiratory. In the acute phase, HCO3⁻ rises only about 1 mEq/L for each 10 mm Hg rise in PaCO2. From a baseline HCO3⁻ of 24 and PaCO2 of 40, that predicts about 26 mEq/L; 27 is consistent with that approximate response. The opioid history points to hypoventilation.

  • B would usually produce a larger bicarbonate rise from renal compensation. Using about 3.5 mEq/L per 10 mm Hg, the expected HCO3⁻ would be about 32 mEq/L.
  • C would show low bicarbonate and a compensatory fall in PaCO2, rather than this elevated PaCO2.
  • D includes respiratory alkalosis, which would require a low PaCO2.

Source: American Thoracic Society, Interpretation of ABGs.

Outline mapping: Breadth I.D.5 blood gas analysis

RTC-3 · Clinical judgment: adult, ventilator management

An adult on volume-control ventilation (VT 450 mL, PEEP 8 cm H2O) has a peak inspiratory pressure that has risen from 28 to 42 cm H2O over 30 minutes. The patient is passive during pressure measurements, inspiratory flow and delivered VT are unchanged, and the ventilator circuit is not kinked. Plateau pressure measured during an inspiratory hold is unchanged at 22 cm H2O. You hear coarse rhonchi and see secretions in the endotracheal tube. SpO2 has dropped from 95% to 91%. Which intervention best addresses these findings?

  • A. Prepare for needle decompression
  • B. Increase PEEP to 12 cm H2O
  • C. Preoxygenate, then suction the endotracheal tube
  • D. Decrease tidal volume to 350 mL
Reveal answer

C. Preoxygenate, then suction the endotracheal tube.

Peak pressure is rising while plateau pressure holds steady. With inspiratory flow and tidal volume unchanged, that supports increased resistance rather than a new reduction in respiratory-system compliance. Coarse breath sounds and visible secretions support suctioning. Preoxygenate before suctioning, then reassess airway pressures and oxygenation.

  • A treats tension pneumothorax, which the findings in this stem do not establish.
  • B does not remove the retained secretions.
  • D changes ventilation without clearing the suspected obstruction. A tidal volume of 350 mL is not inherently inadequate; that depends on the patient and the rest of the ventilator settings.

Sources: AARC Clinical Practice Guidelines: Artificial Airway Suctioning; SOCCA, ICU Residents’ Guide.

Outline mapping: Breadth III.B.2 artificial-airway suctioning; II.A.9 mechanical-ventilator troubleshooting

RTC-4 · Patient data: compliance

A passively ventilated patient without an air leak has an exhaled VT of 500 mL, a peak pressure of 40 cm H2O, a plateau pressure of 30 cm H2O measured during an inspiratory hold, and a measured total PEEP of 10 cm H2O. What is the static respiratory-system compliance?

  • A. 25 mL/cm H2O
  • B. 16.7 mL/cm H2O
  • C. 12.5 mL/cm H2O
  • D. 50 mL/cm H2O
Reveal answer

A. 25 mL/cm H2O.

Static respiratory-system compliance = VT ÷ (plateau pressure − total PEEP) = 500 ÷ (30 − 10) = 25 mL/cm H2O. Remember the pairing: static compliance uses plateau pressure, and dynamic compliance uses peak pressure.

  • B uses peak pressure: 500 ÷ (40 − 10) ≈ 16.7. That's dynamic compliance.
  • C divides by peak pressure without subtracting PEEP: 500 ÷ 40 = 12.5.
  • D divides by PEEP alone: 500 ÷ 10 = 50.

Sources: SOCCA, ICU Residents’ Guide; AARC Clinical Practice Guideline: Patient-Ventilator Assessment.

Outline mapping: Breadth I.C.8 / I.D.9 compliance and resistance

RTC-5 · Clinical judgment: adult, ARDS

A man who is 5 ft 10 in tall and weighs 110 kg is intubated for ARDS. Using a lung-protective strategy of 6 mL/kg predicted body weight, what tidal volume corresponds to that target?

  • A. About 440 mL
  • B. About 580 mL
  • C. About 660 mL
  • D. About 880 mL
Reveal answer

A. About 440 mL.

Predicted body weight for men = 50 + 2.3 × (height in inches − 60). Here that's 50 + 2.3 × 10 = 73 kg. At 6 mL/kg, the tidal volume is 438 mL. Then check plateau pressure and keep it at or below 30 cm H2O.

  • B (about 584) uses 8 mL/kg of predicted body weight, rather than the 6 mL/kg target specified in the question.
  • C (660) uses his actual weight, which overestimates lung size in a heavier patient.
  • D uses 8 mL/kg of actual weight.

Source: NIH NHLBI ARDS Clinical Network, Mechanical Ventilation Protocol Summary.

Outline mapping: Depth: Adults–Medical–ARDS; Breadth III.C.3

RTC-6 · Devices and safety: infection prevention

You're ordered to do a sputum induction on a patient with suspected active pulmonary tuberculosis. Which setup is appropriate in addition to Standard Precautions?

  • A. Droplet precautions with a surgical mask
  • B. An airborne infection isolation room and a fit-tested N95 respirator, or higher respiratory protection selected for the procedure
  • C. Contact precautions with gown and gloves only
  • D. Standard precautions only, since TB isn't confirmed
Reveal answer

B. An airborne infection isolation room and a fit-tested N95 respirator, or higher respiratory protection selected for the procedure.

Suspected infectious pulmonary TB calls for airborne precautions before confirmation. Sputum induction induces coughing and increases the opportunity for airborne transmission. An airborne infection isolation room with appropriate respiratory protection is suitable; CDC also permits a properly ventilated sputum-induction booth. At least N95 respiratory protection is needed for staff performing the procedure, with higher protection considered according to the risk assessment.

  • A provides insufficient respiratory protection for this airborne exposure.
  • C does not address inhalation of infectious airborne particles.
  • D is wrong because airborne precautions begin when infectious pulmonary TB is suspected.

Source: CDC, Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings.

Outline mapping: Breadth II.B.1 infection prevention and control

For more practice, NBRC offers a free official RT practice exam through its RT Exam page in the same software as the real test. You have to finish it in one sitting.

What's on the RT Exam (January 2027 outline)

The RT Exam has 160 scored items in two portions, plus 25 unscored pretest items. Four hours for 185 items works out to about 78 seconds per item.

Breadth of Knowledge: 100 items

Domain Items Recall Application + analysis
I. Patient Data 25 6 19
II. Management of Devices and Patient Safety Procedures 25 8 17
III. Initiation and Modification of Interventions 50 9 41

Depth of Clinical Judgment: 60 items (application and analysis only)

Patient type Items
Adult chronic lung disease 17
Adult medical (infectious disease 5, ARDS 5, other 5) 15
Adult cardiovascular 5
Adult pre- and post-operative care 5
Adult trauma 4
Adult neurological or neuromuscular 4
Neonatal (resuscitation 3, respiratory distress syndrome 3) 6
Pediatric 4

More of the 60 clinical-judgment items:

  • By task: 20 ask you to gather information and 40 ask you to make decisions.
  • By setting: 46 take place in a hospital and 14 outside one.

Across the 160 scored items, 15 to 18 involve neonatal or pediatric patients.

What this means for studying: only 23 of the 160 scored items are pure recall. The other 137, about 86%, ask you to apply or analyze. Learn your formulas and normal values, but spend most of your time on cases: reading blood gases, troubleshooting ventilators, and choosing the next step. Item counts show what's covered, not how hard a topic is or how long it will take you.

Read the full RT Exam Detailed Content Outline (PDF)

Keeping your credential current

CRT and RRT credentials issued since July 1, 2002 run for five years. CRT and RRT credentials earned before that date don't expire. Keep a time-limited credential active through the Credential Maintenance Program, using one of three options:

  • Use NBRC's quarterly online assessments and/or continuing education. Assessment performance determines whether you need 0, 15, or 30 CE hours for CRT/RRT maintenance; without assessments, the CE requirement is 30 hours.
  • Pass the exam for your highest credential again during the last year of your five-year term.
  • Earn a different NBRC credential, which restarts the clock on all of them.

If your credential lapses, you can reinstate it within six months by entering qualifying CE earned during the expired credential's five-year term and paying $250. CE earned after expiration does not count for this route. After six months, you have to meet the admission rules then in effect, pay the new-applicant examination fee, and pass the required exam. The exam-based maintenance options use examination fees instead of the assessment/CE-route CMP fee. (NBRC CMP brochure, options, fees, and If Your Credential Expires)

Renewing with NBRC doesn't renew your state license, and renewing your license doesn't update NBRC. Track both. (NBRC Resources FAQs, NBRC: Credential vs State License Renewal)

After CRT or RRT: specialty credentials

Credential Who can apply
Adult Critical Care (RRT-ACCS) RRT for at least one year
Neonatal/Pediatric (NPS) RRT
Sleep Disorders (SDS) CRT for 6+ months, RRT for 3+ months, or a CRT/RRT who completed a CoARC-accredited program with a sleep add-on track
Pulmonary Function (CPFT/RPFT) Age 18+ and CRT or RRT, among other routes
Asthma Educator (AE-C) Current, active, unrestricted U.S. CRT or RRT credential, among other licenses and routes

Source: NBRC Resources FAQs. Check each exam's page before applying.

Quick answers

Can I take the RT Exam before I graduate? For the standard CoARC graduate route, no. You must be a graduate of a qualifying CoARC program with at least an associate degree.

If I'm a CRT and fail the RT Exam, do I lose my CRT? No. You can keep retaking it to earn the RRT.

Do I need a bachelor's degree to become an RRT? No. For the standard CoARC graduate route, an associate degree from a qualifying program is the minimum for both credentials.

Is the exam online? No. All NBRC exams are taken at PSI testing centers.

Verify any NBRC credential · NBRC Candidate Handbook

Sources

Last verified October 29, 2026: NBRC exam routes, dates, formats, fees, eligibility, maintenance terms, specialty admissions, and content outline; CoARC program categories and education standards; the cited state requirements and Alaska transition; and the sources and calculations for the six original questions.

We use AI-assisted tools in our editorial workflow. See our methodology for how source checks differ from professional review.

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the National Board for Respiratory Care. Exam and credential names identify their subjects; trademarks belong to their respective owners. The practice questions on this page are original and are not official NBRC exam items. Confirm licensing requirements with your state board before you apply.