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Missouri Respiratory Therapy — Requirements & Free Practice

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Conditional License to Practice as a Respiratory Care Practitioner

Nonrenewable full-practice authorization while the licensing background check is pending, after a prima facie showing of full qualification; ends on the Board decision and in no event lasts longer than twelve months.

Licensing authority: Missouri Board for Respiratory Care · Application information

Conditional licensure on equivalent outside licensure and an active RRT while background review is pending
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
Expiration
The Board decision ends the conditional license; it lasts no more than twelve months, is nonrenewable and carries no issuance fee. False or misleading information may cause termination with certified-mail or personal-service notice.
License held elsewhere
RSMo 334.870(1)(b)b requires current licensure or registration elsewhere, an active RRT credential, practice there, and Board determination that the jurisdiction standards equal or exceed Missouri requirements. No one-year holding period is imposed by this profession-specific route.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Pending background
RSMo 334.870(3) requires completion of subdivision (1) and submission of background-check information, a prima facie showing of full qualifications, and Board issuance while the background result is pending.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Conditional licensure on a qualifying NBRC credential while background review is pending
Accepted credential
RSMo 334.870(1)(b)a,c requires either an active NBRC RRT (or successor credential) or an active NBRC CRT earned before January 1, 2027. The CRT pathway is TMC; the RRT pathway requires TMC at its higher cut point and CSE. The cutoff attaches to earning CRT, not to the date of a Missouri application or license expiration.
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
Expiration
The Board decision ends the conditional license; it lasts no more than twelve months, is nonrenewable and carries no issuance fee. False or misleading information may cause termination with certified-mail or personal-service notice.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Pending background
RSMo 334.870(3) requires completion of subdivision (1) and submission of background-check information, a prima facie showing of full qualifications, and Board issuance while the background result is pending.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Successor credential
A successor credentialing organization is allowed for RRT by RSMo 334.870(1)(b)a. No currently offered named additional examination is specified for that open slot; this permission is an applicant condition.

Inactive Respiratory Care Practitioner License

Biennially renewed inactive form of the practitioner license; respiratory care practice is prohibited until reactivation.

Licensing authority: Missouri Board for Respiratory Care · Application information

Election of inactive status at biennial renewal
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Existing license
Hold a Missouri respiratory care practitioner license and elect inactive status at renewal instead of submitting continuing-education proof. RSMo 334.880.4.
Practice prohibition
No respiratory care practice is allowed while the license is inactive. RSMo 334.880.5 and 20 CSR 2255-2.050(3).
Renewal fee
Pay the inactive fee and submit updated renewal information; inactive licenses renew biennially.
Biennial renewal of an already inactive license
Continuing education
RSMo 334.880.4 permits inactive renewal in lieu of continuing-education completion.
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Existing inactive license
Hold an inactive license, submit the completed renewal with updated information and pay the inactive fee before expiration. 20 CSR 2255-2.050(1)-(2).
Practice prohibition
The inactive license authorizes no respiratory care practice.

Respiratory Care Practitioner License

Missouri license for respiratory care practice; CRT and RRT are accepted national qualification credentials rather than separate Missouri licenses. Governing sources are RSMo 334.800-334.930 and 20 CSR 2255 chapters 1-5.

Licensing authority: Missouri Board for Respiratory Care · Application information

Licensure based on equivalent licensure or registration elsewhere and an active RRT
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
License held elsewhere
RSMo 334.870(1)(b)b requires current licensure or registration elsewhere, an active RRT credential, practice there, and Board determination that the jurisdiction standards equal or exceed Missouri requirements. No one-year holding period is imposed by this profession-specific route.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Initial licensure based on an active qualifying NBRC credential
Accepted credential
RSMo 334.870(1)(b)a,c requires either an active NBRC RRT (or successor credential) or an active NBRC CRT earned before January 1, 2027. The CRT pathway is TMC; the RRT pathway requires TMC at its higher cut point and CSE. The cutoff attaches to earning CRT, not to the date of a Missouri application or license expiration.
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Successor credential
A successor credentialing organization is allowed for RRT by RSMo 334.870(1)(b)a. No currently offered named additional examination is specified for that open slot; this permission is an applicant condition.
Relicensure after a lapse longer than four years
Accepted credential
RSMo 334.870(1)(b)a,c requires either an active NBRC RRT (or successor credential) or an active NBRC CRT earned before January 1, 2027. The CRT pathway is TMC; the RRT pathway requires TMC at its higher cut point and CSE. The cutoff attaches to earning CRT, not to the date of a Missouri application or license expiration.
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Board waiver
20 CSR 2255-2.060(5) states a waiver for a licensee whose license has been inactive for four or more years after at least two consecutive years of active respiratory practice elsewhere immediately before application, averaging at least twenty hours per week in a clinical setting; if granted, subsection (3) applies. Its actual reference to inactive status is preserved rather than silently rewritten as lapsed status.
Continuing education
Also provide at least twenty-four approved continuing-education hours in the preceding two years.
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
Lapse duration
20 CSR 2255-2.060(4): more than four years since expiration; apply under the initial licensing requirements currently in effect.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Successor credential
A successor credentialing organization is allowed for RRT by RSMo 334.870(1)(b)a. No currently offered named additional examination is specified for that open slot; this permission is an applicant condition.
Reinstatement of a license lapsed more than thirty days but less than four years
Continuing education
Show at least twenty-four approved hours in the preceding two years.
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Fees
Pay the late renewal fee, renewal fees for each lapsed year and the current renewal fee.
Lapse duration
20 CSR 2255-2.060(3): more than thirty days but less than four years after expiration.
Practice statements
State that no Missouri practice is presently occurring and disclose any practice during lapse. If practice occurred, submit a notarized statement that work ceased when lapse was realized and obtain the employer confirmation required by 2.060(3)(C).
Reinstatement of a license lapsed fewer than thirty days
Continuing education
RSMo 334.880.1 and 20 CSR 2255-4.010 require twenty-four approved continuing-education hours during the preceding two-year cycle, including at least twelve traditional live hours; the first renewal after initial licensing is exempt from continuing education. Board waiver for full-time military service or incapacitating illness is governed by 4.010(10).
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Lapse duration
20 CSR 2255-2.060(2): fewer than thirty days lapsed; postmark the completed renewal and proper fee no later than the thirtieth day. Explanation is presumed satisfactory; disciplinary proceedings may prevent discretionary renewal.
Renewal form and fee
Submit the completed biennial renewal form, updated information and proper fee before expiration; receipt of a notice or depositing a fee does not determine renewal. 20 CSR 2255-2.040.
Reactivation after four or more years of inactive status
Additional unnamed examination
20 CSR 2255-2.050(5) states: (5) In addition to the requirements set forth in section (4) above, a licensee whose license is inactive for four (4) years or more shall be required to successfully complete an entry level examination approved by the board prior to reactivation. The rule does not identify a particular additional currently offered examination; this extra slot is a condition and does not create an invented exam or version.
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Examination waiver
20 CSR 2255-2.050(6) allows the Board to waive the extra examination upon verified active respiratory practice elsewhere for two consecutive years immediately before application, at least twenty hours weekly in a clinical setting. If waived, subsection (4) requirements remain.
Inactive duration
Four or more years of inactive status under 20 CSR 2255-2.050(5).
Renewal and education
Submit the renewal form, pay the active renewal fee and show twenty-four approved continuing-education hours in the preceding two years.
Reactivation after less than four years of inactive status
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Inactive duration
The license has been inactive for less than four years; the extra examination clause in 20 CSR 2255-2.050(5) does not apply.
Renewal and education
Under 20 CSR 2255-2.050(4), submit the renewal form, pay the active renewal fee and show twenty-four approved continuing-education hours in the preceding two years.
General licensure reciprocity with mandatory qualification waiver
No examination is required for this applicant pathway.
Board form credential request
The current Board reciprocity form, MO 375-1094 (9-2025), instruction 6, asks for direct NBRC credential verification: "6. Request verification of your credentials from the National Board for Respiratory Care (NBRC) be sent directly to". The next line names the Missouri Board as the recipient. This implementing request remains visible as a condition; the controlling statutory examination waiver is retained.
Compact eligibility
RSMo 324.009.11 limits this license to Missouri and excludes applicants licensed elsewhere pursuant to an interstate compact.
Fees and fingerprints
RSMo 324.009.7 and .9 preserve applicable fees, bonds or insurance and fingerprint requirements; use the Board reciprocity application and its state/federal background-check process.
Good standing
RSMo 324.009.4 excludes revoked licenses, unresolved complaints or investigations, disqualifying criminal history, lack of good standing or lack of a current license at application. Resolved discipline is reviewed under subsection 4(2).
Prior license
RSMo 324.009.2: hold a valid current license for at least one year from another state, a military branch or unit, a United States territory, or the District of Columbia, in the same occupation and at the same practice level, and provide verification.
Qualifications waiver
RSMo 324.009.3(1): the Board must waive examinations, education and experience within six months when it determines applicable minimum education, experience and clinical supervision requirements existed and the original jurisdiction verifies they were met.

Official no-examination sources

Effective from 2026-08-28.

Expedited reciprocity for a qualifying military or law enforcement spouse
No examination is required for this applicant pathway.
Board form credential request
The current Board reciprocity form, MO 375-1094 (9-2025), instruction 6, asks for direct NBRC credential verification: "6. Request verification of your credentials from the National Board for Respiratory Care (NBRC) be sent directly to". The next line names the Missouri Board as the recipient. This implementing request remains visible as a condition; the controlling statutory examination waiver is retained.
Compact eligibility
RSMo 324.009.11 limits this license to Missouri and excludes applicants licensed elsewhere pursuant to an interstate compact.
Fees and fingerprints
RSMo 324.009.7 and .9 preserve applicable fees, bonds or insurance and fingerprint requirements; use the Board reciprocity application and its state/federal background-check process.
Good standing
RSMo 324.009.4 excludes revoked licenses, unresolved complaints or investigations, disqualifying criminal history, lack of good standing or lack of a current license at application. Resolved discipline is reviewed under subsection 4(2).
Prior license
RSMo 324.009.2: hold a valid current license for at least one year from another state, a military branch or unit, a United States territory, or the District of Columbia, in the same occupation and at the same practice level, and provide verification.
Qualifications waiver
RSMo 324.009.3(2) requires waiver and issuance within thirty days for an otherwise eligible nonresident or resident military or law-enforcement spouse.
Spouse eligibility
Meet the spouse definitions in RSMo 324.009.1(4),(6), including the specified military transfer, Missouri residence or domicile, or qualifying Missouri law-enforcement employment. The current license and one-year requirement in subsection 2 still apply.

Official no-examination sources

Effective from 2026-08-28.

Biennial active license renewal
Continuing education
RSMo 334.880.1 and 20 CSR 2255-4.010 require twenty-four approved continuing-education hours during the preceding two-year cycle, including at least twelve traditional live hours; the first renewal after initial licensing is exempt from continuing education. Board waiver for full-time military service or incapacitating illness is governed by 4.010(10).
Credential audit
RSMo 334.880.3, effective August 28, 2026, makes any license renewal subject to random audit of an active NBRC or successor credential. If audited, direct verification from the credentialing organization is required. The audit condition applies to active and inactive renewal; the current exams underlying CRT/RRT remain referenced even when already passed.
Credential status
Maintain the active NBRC credential required by the statute; an existing qualifying credential is evidence of eligibility and does not itself order a new sitting. Historical examinations no longer offered remain prior credential evidence, rather than requirement leaves.
Renewal form and fee
Submit the completed biennial renewal form, updated information and proper fee before expiration; receipt of a notice or depositing a fee does not determine renewal. 20 CSR 2255-2.040.
Discretionary relicensure after revocation
Accepted credential
RSMo 334.870(1)(b)a,c requires either an active NBRC RRT (or successor credential) or an active NBRC CRT earned before January 1, 2027. The CRT pathway is TMC; the RRT pathway requires TMC at its higher cut point and CSE. The cutoff attaches to earning CRT, not to the date of a Missouri application or license expiration.
Application
Submit the Board application, required fee, identity information and sworn statements; complete the application within six months. 20 CSR 2255-2.010(1)-(2),(7) and MO 375-0241 (9-2025).
Background check
Submit proof of fingerprinting for the state and federal background check, unless fingerprints were already submitted for a Board educational or temporary permit. RSMo 334.805 and 20 CSR 2255-2.010(5).
Board discretion
Relicensure is discretionary and requires all current initial licensing requirements; prior passing and credential status remain applicant conditions.
Credential verification
Arrange direct NBRC verification to the Board; applicant copies of certificates and wallet cards are not accepted. 20 CSR 2255-2.010(3) and application packet instruction 3.
License verification
Every jurisdiction in which a respiratory credential or permit is or has been held must verify it directly, including status, dates and discipline. 20 CSR 2255-2.010(4). This is an applicant condition, not an examination of another jurisdiction.
Prior passing and current version
Exam leaves reference only the supplied current TMC/CSE versions. Prior passing and an active qualifying credential can satisfy eligibility; the leaves do not assert that every applicant must sit the examinations again. Scores of examinations no longer offered are prior evidence recorded with the credential, not extra leaves.
Revocation wait
RSMo 334.920.4: wait at least one year from revocation before applying.
Successor credential
A successor credentialing organization is allowed for RRT by RSMo 334.870(1)(b)a. No currently offered named additional examination is specified for that open slot; this permission is an applicant condition.

Clinical Simulation 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 clinical simulation examination of patient-management problems with information-gathering and decision-making sections; each section of each problem is classified to a minor content heading of the Detailed Content Outline. Admission requires the CRT and a TMC pass at the high cut score; with the implementation of the Respiratory Therapy Examination the CSE is available only to those who passed the TMC at the high cut score by December 31, 2026, and it ends December 31, 2027
Exam questions
22 problems: 20 scored and 2 pretest
Time limit
4 hours
Passing score
Points associated with the candidate’s set of responses are summed across the whole examination into one score compared with a cut score linked to examination committee decisions on whether each positively-scored option is required as a demonstration of minimal competence
Exam fee
$200 for both new and repeat applicants
Examination outline
  • I. PATIENT DATA
    • I.A. Evaluate Data in the Patient Record — 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 — 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 — 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 exercise 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 — 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 exercise 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 — 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 EQUIPMENT, AND INFECTION CONTROL
    • II.A. Assemble /Troubleshoot Devices — 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 — 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 — 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
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways — 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 — 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 device; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation — 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 — 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 — 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 — 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 Techniques in High-Risk Situations — 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 — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, 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 — 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

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