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New York Respiratory Therapy — Requirements & Free Practice

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Respiratory Therapy Technician

Ordinary lifetime professional license; triennial registration and continuing education govern active practice. Polysomnographic technologist authorization is a separate profession, not this license.

Licensing authority: New York State Education Department, Office of the Professions / Board of Regents · Application information

Conditional registration for continuing education deficiency
No examination is required for this applicant pathway.
Additional Education
Complete additional education the Department requires to ensure proper respiratory care.
Duration
At most one year; cannot be renewed or extended.
Existing License
Existing New York license; applicant admits or attests to continuing education noncompliance.
Fees
Pay the conditional registration fee in addition to the ordinary registration and mandatory continuing education fees.
Regular Education
Complete two-thirds of an hour of acceptable continuing education per month during the conditional period.
Remedy
Agree to remedy the continuing education deficiency within the conditional registration period.

Official no-examination sources

Effective from 2026-09-22.

Licensure by endorsement
Therapist Multiple-Choice Examination
Age
Education Law §6506(6)(e) specifies at least 21 for endorsement. The general NYSED requirements page states 18; the statutory endorsement age governs this route.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved one-year respiratory therapy technician certificate program, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC examination CRT. This requirement is mapped to the supplied current TMC version; the passing result must establish CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Examination History
No unsuccessful attempt at a New York licensing examination before or after the endorsement application unless a comparable examination was subsequently passed.
Experience
At least two years of satisfactory professional experience following initial licensure under §59.6.
Prior Conduct
Regents evaluate prior disciplinary action or surrender and may deny endorsement as specified in §6506(6)(h).
Prior License
A license issued by another jurisdiction; education and examination satisfactory to the Board under Education Law §6506(6).
Statutory Immigration Text
Education Law §6506(6)(f) states: "Citizenship or immigration status: be a United States citizen or an alien lawfully admitted for permanent residence in the United States;" NYSED's implementing §59.4 states its current citizenship policy, quoted in the supporting claim sources.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Initial licensure by examination
Therapist Multiple-Choice Examination
Age
At least 18 for ordinary initial licensure.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved one-year respiratory therapy technician certificate program, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC examination CRT. This requirement is mapped to the supplied current TMC version; the passing result must establish CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Experience
Experience satisfactory to the Board and in accordance with the Commissioner's regulations; approved study includes supervised clinical preparation.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Triennial registration renewal
No examination is required for this applicant pathway.
Continuing Education
Complete 24 hours of acceptable continuing education per triennium, with at most 12 hours of self-study; certify compliance or a qualifying exemption/adjustment.
Exemptions
First registration after examination licensure is exempt (endorsement is excluded by the implementing rule); inactive practice and documented good cause have the exemptions/adjustments in §79-4.7(a).
Existing License
Hold the existing New York lifetime license.
Records
Keep continuing education documentation for six years under §79-4.7(e).
Registration
Submit registration application and fees; do not practice without current registration.

Official no-examination sources

Effective from 2026-09-22.

Resume practice after a registration lapse with continuous lawful practice elsewhere
No examination is required for this applicant pathway.
External Practice
Applicant did lawfully practice continuously in another jurisdiction during the lapse.
Lapse Education
Complete two-thirds of an hour per month of lapsed registration, capped at 24 hours, in the new registration period or in the 36 months before it through its conclusion.
New Period
Meet the regular continuing education requirement during the new registration period.
Previous Deficiency
Complete continuing education due for the portion of the last period in which the applicant was registered.
Registration Lapse
Existing lifetime New York license with lapsed registration; possess the new registration certificate before resuming practice.

Official no-examination sources

Effective from 2026-09-22.

Resume practice after a registration lapse without continuous lawful practice elsewhere
No examination is required for this applicant pathway.
External Practice
Applicant did not lawfully practice continuously in another jurisdiction during the lapse.
Lapse Education
Complete two-thirds of an hour per month of lapsed registration, capped at 24 hours, during the 12 months before the new registration period.
New Period
Complete at least 8 hours in each succeeding 12-month period until the next registration date.
Previous Deficiency
Complete continuing education due for the portion of the last period in which the applicant was registered.
Registration Lapse
Existing lifetime New York license with lapsed registration; possess the new registration certificate before resuming practice.

Official no-examination sources

Effective from 2026-09-22.

Individual licensure waiver for substantial compliance
Therapist Multiple-Choice Examination
Age
At least 18 for ordinary initial licensure.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved one-year respiratory therapy technician certificate program, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC examination CRT. This requirement is mapped to the supplied current TMC version; the passing result must establish CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Experience
Experience satisfactory to the Board and in accordance with the Commissioner's regulations; approved study includes supervised clinical preparation.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Waiver Petition
Applicant requests Regents relief from an education, experience or examination requirement that has been substantially met; the Committee on the Professions reviews and recommends to the Regents under §24.7(a)(1).
Restoration following temporary voluntary surrender for incapacity
No examination is required for this applicant pathway.
Prior Surrender
License was voluntarily and temporarily surrendered for drug/alcohol-related incapacity under Education Law §6510-b, without resulting harm to a patient or client.
Rehabilitation
Satisfy the Department that the applicant is not incapacitated for active practice; comply with the approved rehabilitation/treatment program and reasonable protective conditions the Commissioner imposes.
Scope
This route is distinct from restoration of a revoked license under §24.7(a)(2).

Official no-examination sources

Effective from 2026-09-22.

Respiratory Therapist

Ordinary lifetime professional license; triennial registration and continuing education govern active practice. Polysomnographic technologist authorization is a separate profession, not this license.

Licensing authority: New York State Education Department, Office of the Professions / Board of Regents · Application information

Conditional registration for continuing education deficiency
No examination is required for this applicant pathway.
Additional Education
Complete additional education the Department requires to ensure proper respiratory care.
Duration
At most one year; cannot be renewed or extended.
Existing License
Existing New York license; applicant admits or attests to continuing education noncompliance.
Fees
Pay the conditional registration fee in addition to the ordinary registration and mandatory continuing education fees.
Regular Education
Complete five-sixths of an hour of acceptable continuing education per month during the conditional period.
Remedy
Agree to remedy the continuing education deficiency within the conditional registration period.

Official no-examination sources

Effective from 2026-09-22.

Licensure by endorsement
Age
Education Law §6506(6)(e) specifies at least 21 for endorsement. The general NYSED requirements page states 18; the statutory endorsement age governs this route.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved associate or higher degree program in respiratory therapy, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC credential examinations CRT and RRT (written and simulation). These requirements are mapped to the supplied current NBRC TMC and CSE versions; passing results must establish the required RRT level, not merely CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Examination History
No unsuccessful attempt at a New York licensing examination before or after the endorsement application unless a comparable examination was subsequently passed.
Experience
At least two years of satisfactory professional experience following initial licensure under §59.6.
Prior Conduct
Regents evaluate prior disciplinary action or surrender and may deny endorsement as specified in §6506(6)(h).
Prior License
A license issued by another jurisdiction; education and examination satisfactory to the Board under Education Law §6506(6).
Statutory Immigration Text
Education Law §6506(6)(f) states: "Citizenship or immigration status: be a United States citizen or an alien lawfully admitted for permanent residence in the United States;" NYSED's implementing §59.4 states its current citizenship policy, quoted in the supporting claim sources.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Initial licensure by examination
Age
At least 18 for ordinary initial licensure.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved associate or higher degree program in respiratory therapy, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC credential examinations CRT and RRT (written and simulation). These requirements are mapped to the supplied current NBRC TMC and CSE versions; passing results must establish the required RRT level, not merely CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Experience
Experience satisfactory to the Board and in accordance with the Commissioner's regulations; approved study includes supervised clinical preparation.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Triennial registration renewal
No examination is required for this applicant pathway.
Continuing Education
Complete 30 hours of acceptable continuing education per triennium, with at most 15 hours of self-study; certify compliance or a qualifying exemption/adjustment.
Exemptions
First registration after examination licensure is exempt (endorsement is excluded by the implementing rule); inactive practice and documented good cause have the exemptions/adjustments in §79-4.6(a).
Existing License
Hold the existing New York lifetime license.
Records
Keep continuing education documentation for six years under §79-4.6(e).
Registration
Submit registration application and fees; do not practice without current registration.

Official no-examination sources

Effective from 2026-09-22.

Resume practice after a registration lapse with continuous lawful practice elsewhere
No examination is required for this applicant pathway.
External Practice
Applicant did lawfully practice continuously in another jurisdiction during the lapse.
Lapse Education
Complete five-sixths of an hour per month of lapsed registration, capped at 30 hours, in the new registration period or in the 36 months before it through its conclusion.
New Period
Meet the regular continuing education requirement during the new registration period.
Previous Deficiency
Complete continuing education due for the portion of the last period in which the applicant was registered.
Registration Lapse
Existing lifetime New York license with lapsed registration; possess the new registration certificate before resuming practice.

Official no-examination sources

Effective from 2026-09-22.

Resume practice after a registration lapse without continuous lawful practice elsewhere
No examination is required for this applicant pathway.
External Practice
Applicant did not lawfully practice continuously in another jurisdiction during the lapse.
Lapse Education
Complete five-sixths of an hour per month of lapsed registration, capped at 30 hours, during the 12 months before the new registration period.
New Period
Complete at least 10 hours in each succeeding 12-month period until the next registration date.
Previous Deficiency
Complete continuing education due for the portion of the last period in which the applicant was registered.
Registration Lapse
Existing lifetime New York license with lapsed registration; possess the new registration certificate before resuming practice.

Official no-examination sources

Effective from 2026-09-22.

Individual licensure waiver for substantial compliance
Age
At least 18 for ordinary initial licensure.
Application
Submit Form 1, the licensure fee, school certification and any required verification of licenses ever held; examination results must come from NBRC.
Character
Good moral character as determined by NYSED.
Citizenship
NYSED applies §59.4 (effective June 1, 2016): citizenship or immigration status does not by itself disqualify an otherwise qualified applicant, subject to applicable federal restrictions and the stated lawful-presence/DACA provisions.
Education
High school or equivalent and an approved associate or higher degree program in respiratory therapy, or a Department-determined equivalent.
Education Review
NYS licensure-qualifying or CoARC-accredited programs use school certification; other programs require Department approval and an official transcript and other needed information.
English
Under §59.3, study in a country whose principal language is not English requires an acceptable English proficiency examination or an acceptable licensing examination given in English; a language test is an applicant condition.
Exam Evidence
NYSED calls the required NBRC credential examinations CRT and RRT (written and simulation). These requirements are mapped to the supplied current NBRC TMC and CSE versions; passing results must establish the required RRT level, not merely CRT qualification.
Exam Timing
Education must be completed before licensure, but §79-4.3 permits examination admission beforehand and removes §59.5(f) grade-retention limitations. Passing standards are determined by the Board.
Experience
Experience satisfactory to the Board and in accordance with the Commissioner's regulations; approved study includes supervised clinical preparation.
Waiver
Education Law §6506(5) permits the Regents to waive education, experience or examination requirements upon substantial compliance; individual relief is discretionary and does not remove the named examination leaves.
Waiver Petition
Applicant requests Regents relief from an education, experience or examination requirement that has been substantially met; the Committee on the Professions reviews and recommends to the Regents under §24.7(a)(1).
Restoration following temporary voluntary surrender for incapacity
No examination is required for this applicant pathway.
Prior Surrender
License was voluntarily and temporarily surrendered for drug/alcohol-related incapacity under Education Law §6510-b, without resulting harm to a patient or client.
Rehabilitation
Satisfy the Department that the applicant is not incapacitated for active practice; comply with the approved rehabilitation/treatment program and reasonable protective conditions the Commissioner imposes.
Scope
This route is distinct from restoration of a revoked license under §24.7(a)(2).

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

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