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Hawaii Respiratory Therapy — Requirements & Free Practice

US-HI · License preparation

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Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Respiratory Therapist License

Individual respiratory therapist licensure under HRS chapter 466D. HRS §466D-7 contains practice exemptions; those exemptions are not additional licence types. The director administers the program and may impose individual licence conditions.

Licensing authority: Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division, Respiratory Therapists Program · Application information

Licensure by endorsement

At least one of the following alternatives:

Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Equivalence
The director must deem the other licensing requirements equivalent to or higher than current Hawaii requirements (HRS §466D-9).
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Comparison
The DCCA form compares the requirements at the time of the other licence; HRS §466D-9 controls the equivalence decision against current Hawaii requirements. DCCA also states: "National Certification - Each applicant is required to have passed the Certified Respiratory Therapist Examination (CRT) or Registered Respiratory Therapist Examination (RRT) of the National Board for Respiratory Care (NBRC). You may either attach the NBRC official verification letter to your application (this is preferable to us) or you may request the NBRC to mail us your verification.". The national examination remains referenced even when equivalence or existing credentials excuse the applicant from sitting it again.
Licence Held Elsewhere
Hold a current and unencumbered respiratory therapist licence in another jurisdiction. This other licence and any other jurisdiction-specific examination are applicant conditions, not Hawaii examination leaves.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Verification
Have every jurisdiction in which a licence is or was held verify it directly to DCCA, or attach original licence verification with the issuing authority’s seal.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
Initial licensure by examination
Therapist Multiple-Choice Examination
Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Education
Successfully complete a respiratory therapy training program at an accredited educational institution approved by the Committee on Accreditation for Respiratory Care or its predecessor or successor.
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Wording
DCCA RT-00 0421R states: "National Certification - Each applicant is required to have passed the Certified Respiratory Therapist Examination (CRT) or Registered Respiratory Therapist Examination (RRT) of the National Board for Respiratory Care (NBRC). You may either attach the NBRC official verification letter to your application (this is preferable to us) or you may request the NBRC to mail us your verification.". Its CRT/RRT wording is retained for the applicant; the statute determines the initial route and its ninety-day limit.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Passing Score Window
HRS §466D-8(2) requires passage of the Certified Respiratory Therapist Examination or its successor within ninety days of submitting the application. Prior passage remains an examination leaf; the ninety-day window is an applicant condition.
Practice
Practise only under the order and qualified direction described in HRS §466D-4. HRS §466D-5 gives the director general examination-administration powers but does not identify another currently offered examination for this route.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
Military deployment licence restoration or extension
No examination is required for this applicant pathway.
Deployment
The licence expired, was forfeited or became delinquent while the member of the armed forces, National Guard or reserves was on active duty and deployed during a state or national crisis. A current licence expiring within 120 days after release is also covered.
Documents
Provide deployment and discharge or release orders, plus financial-integrity or federal-requirement documentation if required for renewal.
Exclusions
Scheduled annual or specialized training, suspended or revoked licences, and licences already adjudicated and subject to disciplinary action do not qualify.
Fee
Pay the current renewal fee.
Time Limit
Request restoration within 120 days after discharge or release from active-duty deployment.

Official no-examination sources

Effective from 2026-09-22.

Expedited endorsement for a nonresident military spouse

At least one of the following alternatives:

Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Competency Accommodation
Where a prior period of practice is required, competency as determined by the authority may be demonstrated instead; §466D-9 equivalence and current licensure still apply.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Equivalence
The director must deem the other licensing requirements equivalent to or higher than current Hawaii requirements (HRS §466D-9).
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Comparison
The DCCA form compares the requirements at the time of the other licence; HRS §466D-9 controls the equivalence decision against current Hawaii requirements. DCCA also states: "National Certification - Each applicant is required to have passed the Certified Respiratory Therapist Examination (CRT) or Registered Respiratory Therapist Examination (RRT) of the National Board for Respiratory Care (NBRC). You may either attach the NBRC official verification letter to your application (this is preferable to us) or you may request the NBRC to mail us your verification.". The national examination remains referenced even when equivalence or existing credentials excuse the applicant from sitting it again.
Licence Held Elsewhere
Hold a current and unencumbered respiratory therapist licence in another jurisdiction. This other licence and any other jurisdiction-specific examination are applicant conditions, not Hawaii examination leaves.
Military Spouse
Be a nonresident military spouse. HRS §436B-14.6 requires expedited consideration.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Verification
Have every jurisdiction in which a licence is or was held verify it directly to DCCA, or attach original licence verification with the issuing authority’s seal.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
New licensure after revocation
Therapist Multiple-Choice Examination
Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Discretionary Waiver
Under HRS §436B-21 the authority may waive applicable education or examination requirements when documentation establishes maintained equivalent knowledge, competence and qualifications through work experience, training or education. The current named examination remains a leaf; the waiver is an applicant condition.
Disqualification
HRS §466D-12(g) prohibits restoration, renewal or reinstatement where both its sex-offender-registration and patient/client-offence conditions apply.
Education
Successfully complete a respiratory therapy training program at an accredited educational institution approved by the Committee on Accreditation for Respiratory Care or its predecessor or successor.
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Wording
DCCA RT-00 0421R states: "National Certification - Each applicant is required to have passed the Certified Respiratory Therapist Examination (CRT) or Registered Respiratory Therapist Examination (RRT) of the National Board for Respiratory Care (NBRC). You may either attach the NBRC official verification letter to your application (this is preferable to us) or you may request the NBRC to mail us your verification.". Its CRT/RRT wording is retained for the applicant; the statute determines the initial route and its ninety-day limit.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Passing Score Window
HRS §466D-8(2) requires passage of the Certified Respiratory Therapist Examination or its successor within ninety days of submitting the application. Prior passage remains an examination leaf; the ninety-day window is an applicant condition.
Practice
Practise only under the order and qualified direction described in HRS §466D-4. HRS §466D-5 gives the director general examination-administration powers but does not identify another currently offered examination for this route.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Waiting Period
Apply for a new licence only after five years from the effective date of revocation.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
New licensure after termination for failure to restore
Therapist Multiple-Choice Examination
Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Education
Successfully complete a respiratory therapy training program at an accredited educational institution approved by the Committee on Accreditation for Respiratory Care or its predecessor or successor.
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Wording
DCCA RT-00 0421R states: "National Certification - Each applicant is required to have passed the Certified Respiratory Therapist Examination (CRT) or Registered Respiratory Therapist Examination (RRT) of the National Board for Respiratory Care (NBRC). You may either attach the NBRC official verification letter to your application (this is preferable to us) or you may request the NBRC to mail us your verification.". Its CRT/RRT wording is retained for the applicant; the statute determines the initial route and its ninety-day limit.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Passing Score Window
HRS §466D-8(2) requires passage of the Certified Respiratory Therapist Examination or its successor within ninety days of submitting the application. Prior passage remains an examination leaf; the ninety-day window is an applicant condition.
Practice
Practise only under the order and qualified direction described in HRS §466D-4. HRS §466D-5 gives the director general examination-administration powers but does not identify another currently offered examination for this route.
Prior Termination
The forfeited licence was not restored within one year and automatically terminated. HRS §466D-10 requires a new licence application and current new-applicant requirements.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
Reactivation of an inactive licence
No examination is required for this applicant pathway.
Application
Complete the reactivation application, disclose intervening convictions and discipline, and provide the required supporting records.
Fees
Pay applicable reactivation, active-renewal and compliance-resolution fees according to whether active or inactive renewal fees were paid.
Fitness
HRS §436B-13.3 permits the authority to request fitness information and to deny reactivation on statutory grounds.
Inactive Licence
Hold a respiratory therapist licence on inactive status. The inactive licensee is treated as unlicensed for practice.
Other Requirements
The respiratory therapist row of DCCA’s reactivation requirements table states Other Requirement: None for both fee categories.

Official no-examination sources

Effective from 2026-09-22.

Triennial renewal
No examination is required for this applicant pathway.
Application And Fees
Submit a completed renewal application and applicable renewal fees; renewal of inactive status follows its applicable fee and prohibits practice.
Deadline
Renew triennially by June 30; HRS §466D-10 specifies payment within sixty days before expiration.
Existing Licence
Hold the respiratory therapist licence being renewed.
Forfeiture
Failure to renew forfeits the licence; no practice is permitted unless restored.

Official no-examination sources

Effective from 2026-09-22.

Restoration of a forfeited licence within one year
No examination is required for this applicant pathway.
Application And Fees
Submit the restoration application and pay renewal, restoration, penalty and other applicable fees.
Forfeiture
The licence was forfeited for failure to renew.
Practice
Do not practise until restoration is complete.
Time Limit
Restore within one year of forfeiture; after one year the licence automatically terminates and a new application is required.

Official no-examination sources

Effective from 2026-09-22.

Respiratory Therapist - Temporary Military Spouse License

Temporary respiratory therapist licensing for military spouses under HRS §436B-14.7 and temporary licensing for covered servicemembers or spouses under 50 U.S.C. §4025a(b). DCCA labels its application Military Spouse but the checklist also expressly includes active military servicemembers.

Licensing authority: Hawaii Department of Commerce and Consumer Affairs, Professional and Vocational Licensing Division, Respiratory Therapists Program · Application information

Temporary federal portability licence for a servicemember
No examination is required for this applicant pathway.
Applicant
Be the servicemember receiving the military orders.
Application
Submit military orders and a notarized affidavit of identity, truthful and complete application information, understanding of Hawaii licence requirements and scope, compliance with those requirements, and good standing.
Background Check
The licensing authority may conduct a background check.
Compact
The federal provision does not apply to a licence operating in multiple jurisdictions pursuant to an applicable interstate compact; follow the compact’s requirements if that circumstance applies.
Covered Licence
The licence is in good standing, has no revocation or discipline, no pending unprofessional-conduct investigation, and no voluntary surrender during such investigation; applicant good standing must be affirmed for every jurisdiction in which a licence is or was held.
Relocation
Relocate residence to Hawaii because of the servicemember’s military orders, holding a covered professional licence issued by another United States jurisdiction.
Stale Checklist
DCCA’s current MST-1224 checklist states: "Two Year Active Usage: the license being relied directly to the licensing agency from each state upon must have been actively used by the or province in which applicant holds or has ever servicemember or the servicemember’s spouse held a license. during the two years immediately preceding the servicemember’s relocation orders.". Current 50 U.S.C. §4025a, amended December 23, 2024, defines covered licensure and the application without that former two-year-use condition. The Board’s stated demand remains visible here; the current statute controls.
Temporary Issuance
50 U.S.C. §4025a(b) permits a temporary licence carrying the same rights, privileges and responsibilities as a permanent licence if the authority cannot recognize the covered licence during the 30 days after receiving the application.

Official no-examination sources

Effective from 2026-09-22.

Temporary federal portability licence for a servicemember’s spouse
No examination is required for this applicant pathway.
Applicant
Be the spouse of the servicemember receiving the military orders.
Application
Submit military orders and a notarized affidavit of identity, truthful and complete application information, understanding of Hawaii licence requirements and scope, compliance with those requirements, and good standing.
Background Check
The licensing authority may conduct a background check.
Compact
The federal provision does not apply to a licence operating in multiple jurisdictions pursuant to an applicable interstate compact; follow the compact’s requirements if that circumstance applies.
Covered Licence
The licence is in good standing, has no revocation or discipline, no pending unprofessional-conduct investigation, and no voluntary surrender during such investigation; applicant good standing must be affirmed for every jurisdiction in which a licence is or was held.
Marriage Evidence
Include a copy of the marriage certificate as required by 50 U.S.C. §4025a(c)(2).
Relocation
Relocate residence to Hawaii because of the servicemember’s military orders, holding a covered professional licence issued by another United States jurisdiction.
Stale Checklist
DCCA’s current MST-1224 checklist states: "Two Year Active Usage: the license being relied directly to the licensing agency from each state upon must have been actively used by the or province in which applicant holds or has ever servicemember or the servicemember’s spouse held a license. during the two years immediately preceding the servicemember’s relocation orders.". Current 50 U.S.C. §4025a, amended December 23, 2024, defines covered licensure and the application without that former two-year-use condition. The Board’s stated demand remains visible here; the current statute controls.
Temporary Issuance
50 U.S.C. §4025a(b) permits a temporary licence carrying the same rights, privileges and responsibilities as a permanent licence if the authority cannot recognize the covered licence during the 30 days after receiving the application.

Official no-examination sources

Effective from 2026-09-22.

Temporary military spouse licensure while completing Hawaii requirements

At least one of the following alternatives:

Affidavit
Submit the signed affidavit covering education, examinations, experience, prior employment and criminal-history information.
Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Completion
Complete any remaining requirements for Hawaii licensure; whether TMC must be sat again depends on accepted credentials and equivalence.
Criminal History
Have no disqualifying criminal history as determined by the authority.
Disciplinary History
Meet §436B-14.7(a)(6)-(8): no limited, suspended, revoked or investigatory-surrendered licence; disclose denied applications and discipline so the authority can assess resolution; no surrender of professional staff or association/faculty membership to avoid adverse action.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Duration
The state temporary licence has the profession’s ordinary licensing period but cannot exceed five years in aggregate or the military assignment period.
Examination Condition
HRS §436B-14.7(a)(5) requires passage of examination requirements if required by Hawaii or the other jurisdiction. The identifiable Hawaii examination is the §466D-8 CRT successor (TMC). Another jurisdiction’s own examination and prior licensure are conditions; an applicant excused through equivalent prior qualification need not sit a new examination.
Existing Licence
Hold an active respiratory therapist licence from another United States jurisdiction for at least one year, current and in good standing without conditions or restrictions in every jurisdiction.
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Difference
The current MST-1224 form refers to the earlier federal two-year-active-use requirement. State eligibility follows §436B-14.7; the current federal portability requirements are separately recorded.
Military Status
Be married to an active-duty United States armed forces member and accompany that member on official permanent-change-of-station orders to a military installation in Hawaii.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Pending Requirements
HRS §436B-14.7(c) allows specified services while completing Hawaii licensure requirements, when credentials, experience or national-examination passage are substantially equivalent to or exceed Hawaii standards.
Prior Qualifications
The prior jurisdiction verifies minimum education, applicable work experience and clinical supervision requirements.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Supervision
Perform only specified services under a Hawaii-licensed professional’s supervision where appropriate.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
State temporary licensure for an accompanying military spouse

At least one of the following alternatives:

Affidavit
Submit the signed affidavit covering education, examinations, experience, prior employment and criminal-history information.
Age
Be beyond the age of majority (18 years of age).
Application
Complete and sign the DCCA application; provide legal name, addresses, contact details, Social Security number as authorized, and all requested documents.
Criminal History
Have no disqualifying criminal history as determined by the authority.
Disciplinary History
Meet §436B-14.7(a)(6)-(8): no limited, suspended, revoked or investigatory-surrendered licence; disclose denied applications and discipline so the authority can assess resolution; no surrender of professional staff or association/faculty membership to avoid adverse action.
Disclosures
Disclose criminal convictions and licensing history, investigations and discipline; provide the detailed signed statement and certified documents requested by the application.
Duration
The state temporary licence has the profession’s ordinary licensing period but cannot exceed five years in aggregate or the military assignment period.
Examination Condition
HRS §436B-14.7(a)(5) requires passage of examination requirements if required by Hawaii or the other jurisdiction. The identifiable Hawaii examination is the §466D-8 CRT successor (TMC). Another jurisdiction’s own examination and prior licensure are conditions; an applicant excused through equivalent prior qualification need not sit a new examination.
Existing Licence
Hold an active respiratory therapist licence from another United States jurisdiction for at least one year, current and in good standing without conditions or restrictions in every jurisdiction.
Fees
Pay applicable application, licence and compliance-resolution fees; a dishonoured payment does not satisfy the fee requirement.
Implementation Difference
The current MST-1224 form refers to the earlier federal two-year-active-use requirement. State eligibility follows §436B-14.7; the current federal portability requirements are separately recorded.
Military Status
Be married to an active-duty United States armed forces member and accompany that member on official permanent-change-of-station orders to a military installation in Hawaii.
National Verification
Supply the NBRC official verification letter, preferably attached, or have NBRC mail it to DCCA.
Prior Qualifications
The prior jurisdiction verifies minimum education, applicable work experience and clinical supervision requirements.
Replacement Reading
The official replacement notice says the Therapist Multiple-Choice Examination replaced the CRT and Written Registry Examinations in January 2015. The frozen current TMC version is referenced as the statutory CRT successor. The DCCA form does not separately name the Clinical Simulation Examination; its RRT wording is treated as legacy examination or credential terminology rather than an independently established CSE requirement.
Work Authorization
Be a United States citizen, United States national, or alien authorized to work in the United States.
Renewal of a state military spouse temporary licence
No examination is required for this applicant pathway.
Application And Fees
Submit the completed renewal application and applicable fees under HRS §436B-13.
Duration
The licence has the ordinary respiratory therapist licensing period; its aggregate duration cannot exceed five years or the military assignment period. This route is not renewal of the federal 30-day administrative temporary licence.
Existing Licence
Hold the state temporary licence issued under HRS §436B-14.7(a), and continue satisfying its conditions.

Official no-examination sources

Effective from 2026-09-22.

Therapist Multiple-Choice Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based multiple-choice examination; each scored item is linked to a content area and cognitive level (recall, application, analysis); the TMC ends December 31, 2026 and the Respiratory Therapy Examination is used from January 1, 2027
Exam questions
160 multiple-choice items: 140 scored and 20 pretest
Time limit
3 hours
Passing score
Raw score (each item worth one point) compared with two cut scores: the low cut score earns the CRT credential; the high cut score earns the CRT credential and eligibility for the Clinical Simulation Examination for candidates eligible to earn the RRT
Exam fee
$190 new applicants; $150 repeat applicants
Examination outline
  • I. PATIENT DATA (50 of 140 scored items; Recall 15, Application 27, Analysis 8) (35.71%)
    • I.A. Evaluate Data in the Patient Record (10 of 50 section items; Recall 4, Application 6, Analysis 0) — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, APGAR scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment (10 of 50 section items; Recall 3, Application 6, Analysis 1) — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, APGAR score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information (12 of 50 section items; Recall 4, Application 7, Analysis 1) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary stress testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results (10 of 50 section items; Recall 2, Application 4, Analysis 4) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary stress testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures (8 of 50 section items; Recall 2, Application 4, Analysis 2) — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF DEVICES, AND INFECTION CONTROL (20 of 140 scored items; Recall 8, Application 9, Analysis 3) (14.29%)
    • II.A. Assemble / Troubleshoot Devices (15 of 20 section items; Recall 4, Application 8, Analysis 3) — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention (2 of 20 section items; Recall 2, Application 0, Analysis 0) — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures (3 of 20 section items; Recall 2, Application 1, Analysis 0) — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS (70 of 140 scored items; Recall 10, Application 30, Analysis 30) (50%)
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways (10 of 70 section items; Recall 3, Application 4, Analysis 3) — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques (5 of 70 section items; Recall 2, Application 2, Analysis 1) — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation (15 of 70 section items; Recall 1, Application 5, Analysis 9) — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan (18 of 70 section items; Recall 1, Application 7, Analysis 10) — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice (6 of 70 section items; Recall 0, Application 2, Analysis 4) — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care in High-Risk Situations (5 of 70 section items; Recall 0, Application 2, Analysis 3) — 1. Emergency a. cardiopulmonary emergencies, excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, endobronchial ultrasound (EBUS), navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education (3 of 70 section items; Recall 1, Application 2, Analysis 0) — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources