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North Dakota Respiratory Therapy — Requirements & Free Practice

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Certified Respiratory Therapist

North Dakota respiratory care license. Polysomnographic technologist licensure is a separate profession under sections 43-42-01(7) and 43-42-04.1. Ordinary provisional licensure is not offered under the Board instructions; the statutory military provisional license and temporary permit provisions are retained separately.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Foreign practitioner licensure without a new examination under NDCC 43 51 06
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
Examination Waiver
43-51-06 authorizes issuance without examination while requiring other licensing requirements. Existing NBRC qualification evidence under 105-02-01-01 is retained as currently offered examination references; the applicant may be excused from a new sitting. The statute permits a state-law examination, but identifies no operational Board examination.
Experience
Practice the licensed occupation for at least two years before applying, or a shorter period allowed by statute or Board rule.
Foreign License
Hold and maintain a license in good standing in another jurisdiction, as defined in 43-51-01.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Initial licensure based on NBRC certification
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Renewal after lapse longer than one year within the three year renewal window
No examination is required for this applicant pathway.
Education Catch Up
Supply at least ten approved clock-hours for each lapsed year, up to three years. All late renewal applications are audited.
Fees
Submit the signed renewal application with the renewal and late fees.
Renewal Window
Renewal must be sought within three years of last issuance; after three years the application is a new application.

Official no-examination sources

Effective from 2026-09-22.

Late renewal with lapse not exceeding one year
No examination is required for this applicant pathway.
Application
Submit the signed renewal application and renewal fee.
Education Audit
All late renewal applications are audited and must provide proof of continuing education; the ordinary ten-hour annual requirement applies.
Lapse
Renewal is sought within three years of the last issuance, and the lapse does not exceed one year.
Late Fee
Late renewal is delinquent and incurs the Board late charge.

Official no-examination sources

Effective from 2026-09-22.

Military member or military spouse full licensure under NDCC 43 51 11.1(1)
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Case By Case Exception
The Board must adopt rules or grant case-by-case exceptions to licensing standards. Demonstrate competency through Board-determined methods, and the Board must find no substantial increase in public risk. NBRC examination requirements are the ordinary standards that may be excused; the exception is an applicant condition.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
Military Fee
The Board October 23, 2024 application states that the fee is waived for qualifying military members or spouses.
Military Status
Qualify as a military member or military spouse under 43-51-01 and provide satisfactory proof; the Board paper application requests military orders or military spouse status.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
License renewal with military hardship exceptions
No examination is required for this applicant pathway.
Continuing Education
Ordinary requirement is ten approved clock-hours; the Board determines an applicable hardship exception.
Exception
The Board must provide renewal exceptions by rule or case by case to address resulting compliance hardships; ordinary annual renewal requirements otherwise apply.
Military Status
A National Guard member or military member activated for more than thirty days, or a military member serving in a theater or area of armed conflict.

Official no-examination sources

Effective from 2026-09-22.

Reciprocity under NDCC 43 42 06
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Reciprocity
The Board may grant a license on satisfactory proof of a respiratory-care license issued under laws imposing substantially the same requirements as NDCC chapter 43-42, and payment of the annual fee. The general initial-application rule requires NBRC credential evidence. No new sitting is asserted solely because this is a reciprocity application.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Annual license renewal
No examination is required for this applicant pathway.
Continuing Education
Complete at least ten Board-approved clock-hours in the preceding calendar year; under extraordinary circumstances the Board may consider same-year hours.
Initial November License
105-02-01-03 exempts a therapist initially licensed after November 1 from renewal for one year.
Renewal Application
Submit a signed renewal application and fee by December 31 preceding the renewal year.

Official no-examination sources

Effective from 2026-09-22.

Renewal or reissuance of suspended or revoked license within the renewal window
No examination is required for this applicant pathway.
Board Conditions
Satisfy every condition established by the Board for renewal or reissuance and pay the Board fee under 43-42-03(7). That provision does not identify an examination; an individualized Board order is an applicant condition.
Continuing Education
Demonstrate satisfactory completion of continuing study under 43-42-03(8) and the applicable requirements of 105-02-01-04.
Prior License
Previously licensed by the Board; license has been suspended or revoked.
Window
This route applies within the three-year renewal window without triggering entry-level recredentialing. Beyond that boundary, the new-application/recredentialing route applies.

Official no-examination sources

Effective from 2026-09-22.

Reissuance after suspension or revocation with three year lapse and new application
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Disciplinary Restoration
Satisfy the Board conditions imposed under 43-42-03(7), pay its reissuance fee, and demonstrate continuing study. The three-year lapse and new-application rules also apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
New application and entry level recredentialing after a three year license lapse
Therapist Multiple-Choice Examination
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Renewal Boundary
Under 105-02-01-02(4), an application after three years from the last issuance is a new application. Under 105-02-01-01(3), failure to maintain licensure for three years requires entry-level recredentialing. A registry credential remains required for the RRT license; applicant-specific Board conditions govern reliance on an existing registry credential.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Universal licensure under NDCC 43 51.1 02
Therapist Multiple-Choice Examination
Applicability
Applies unless the Board is part of an effective interstate compact, an executed license transfer, existing interstate mobility, or reciprocity agreement. Statutory reciprocity authority alone does not establish an executed agreement.
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Competency
Demonstrate competency and education through methods determined by the Board; general initial-application NBRC qualification evidence is retained.
Criminal Check
Submit to a state and federal criminal background check if required by the Board with statutory authority, and pay established fees.
Discipline
No discipline in a jurisdiction in which licensed during the last ten years, and no active investigation by another licensing or disciplinary authority or law enforcement.
Disqualifying Acts
No act constituting grounds for refusal, suspension or revocation unless the Board determines it is not an impediment.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Out Of State License
Hold an out-of-state license with comparable requirements and actively have used it for two of the three years immediately preceding application.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).

Military Provisional License — Certified Respiratory Therapist

Statutory military provisional authorization under NDCC 43-51-11.1. The law allows a provisional license or temporary permit; form selection is made by the Board. Retained notwithstanding the lower-ranked general Board statement that ordinary provisional licensure is no longer offered. This is not an ordinary graduate temporary license.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Military provisional issuance on substantial compliance
Therapist Multiple-Choice Examination
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Duration
No longer than two years and valid only while making progress toward unmet requirements, subject to the statutory termination events.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.
Automatic military provisional issuance after thirty days without Board disposition
Therapist Multiple-Choice Examination
Automatic Duration
An automatic authorization remains valid until the Board grants or denies the application or issues a provisional license or temporary permit under subsection 2; subsection 5 states this distinct validity rule.
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Deadline
Thirty days after receipt of a completed military application, if the Board has neither granted nor denied the full license nor issued an authorization under subsection 2, it must automatically issue the provisional license or temporary permit.
Duration
Subsection 5 supplies the validity period for this automatic issuance; the two-year rule quoted from subsection 2 describes the replacement authorization issued under subsection 2.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.

Military Temporary Permit — Certified Respiratory Therapist

Statutory military provisional authorization under NDCC 43-51-11.1. The law allows a provisional license or temporary permit; form selection is made by the Board. Retained notwithstanding the lower-ranked general Board statement that ordinary provisional licensure is no longer offered. This is not an ordinary graduate temporary license.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Military provisional issuance on substantial compliance
Therapist Multiple-Choice Examination
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Duration
No longer than two years and valid only while making progress toward unmet requirements, subject to the statutory termination events.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.
Automatic military provisional issuance after thirty days without Board disposition
Therapist Multiple-Choice Examination
Automatic Duration
An automatic authorization remains valid until the Board grants or denies the application or issues a provisional license or temporary permit under subsection 2; subsection 5 states this distinct validity rule.
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Deadline
Thirty days after receipt of a completed military application, if the Board has neither granted nor denied the full license nor issued an authorization under subsection 2, it must automatically issue the provisional license or temporary permit.
Duration
Subsection 5 supplies the validity period for this automatic issuance; the two-year rule quoted from subsection 2 describes the replacement authorization issued under subsection 2.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.

Registered Respiratory Therapist

North Dakota respiratory care license. Polysomnographic technologist licensure is a separate profession under sections 43-42-01(7) and 43-42-04.1. Ordinary provisional licensure is not offered under the Board instructions; the statutory military provisional license and temporary permit provisions are retained separately.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Upgrade an existing North Dakota CRT license to RRT
Existing CRT
Hold the existing North Dakota Certified Respiratory Therapist license; its currently offered certifying examination remains a prior-pass reference.
Registry Qualification
The statutory RRT registry-examination requirement applies; an existing qualifying NBRC registry record is submitted rather than asserting every upgrader must retake each examination.
Upgrade Evidence
Email a copy of the NBRC Clinical Simulation Exam report to the Board office. The Board states no upgrade fee is required.
Foreign practitioner licensure without a new examination under NDCC 43 51 06
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
Examination Waiver
43-51-06 authorizes issuance without examination while requiring other licensing requirements. Existing NBRC qualification evidence under 105-02-01-01 is retained as currently offered examination references; the applicant may be excused from a new sitting. The statute permits a state-law examination, but identifies no operational Board examination.
Experience
Practice the licensed occupation for at least two years before applying, or a shorter period allowed by statute or Board rule.
Foreign License
Hold and maintain a license in good standing in another jurisdiction, as defined in 43-51-01.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Initial licensure based on NBRC registry credential
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Renewal after lapse longer than one year within the three year renewal window
No examination is required for this applicant pathway.
Education Catch Up
Supply at least ten approved clock-hours for each lapsed year, up to three years. All late renewal applications are audited.
Fees
Submit the signed renewal application with the renewal and late fees.
Renewal Window
Renewal must be sought within three years of last issuance; after three years the application is a new application.

Official no-examination sources

Effective from 2026-09-22.

Late renewal with lapse not exceeding one year
No examination is required for this applicant pathway.
Application
Submit the signed renewal application and renewal fee.
Education Audit
All late renewal applications are audited and must provide proof of continuing education; the ordinary ten-hour annual requirement applies.
Lapse
Renewal is sought within three years of the last issuance, and the lapse does not exceed one year.
Late Fee
Late renewal is delinquent and incurs the Board late charge.

Official no-examination sources

Effective from 2026-09-22.

Military member or military spouse full licensure under NDCC 43 51 11.1(1)
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Case By Case Exception
The Board must adopt rules or grant case-by-case exceptions to licensing standards. Demonstrate competency through Board-determined methods, and the Board must find no substantial increase in public risk. NBRC examination requirements are the ordinary standards that may be excused; the exception is an applicant condition.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
Military Fee
The Board October 23, 2024 application states that the fee is waived for qualifying military members or spouses.
Military Status
Qualify as a military member or military spouse under 43-51-01 and provide satisfactory proof; the Board paper application requests military orders or military spouse status.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
License renewal with military hardship exceptions
No examination is required for this applicant pathway.
Continuing Education
Ordinary requirement is ten approved clock-hours; the Board determines an applicable hardship exception.
Exception
The Board must provide renewal exceptions by rule or case by case to address resulting compliance hardships; ordinary annual renewal requirements otherwise apply.
Military Status
A National Guard member or military member activated for more than thirty days, or a military member serving in a theater or area of armed conflict.

Official no-examination sources

Effective from 2026-09-22.

Reciprocity under NDCC 43 42 06
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Reciprocity
The Board may grant a license on satisfactory proof of a respiratory-care license issued under laws imposing substantially the same requirements as NDCC chapter 43-42, and payment of the annual fee. The general initial-application rule requires NBRC credential evidence. No new sitting is asserted solely because this is a reciprocity application.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Annual license renewal
No examination is required for this applicant pathway.
Continuing Education
Complete at least ten Board-approved clock-hours in the preceding calendar year; under extraordinary circumstances the Board may consider same-year hours.
Initial November License
105-02-01-03 exempts a therapist initially licensed after November 1 from renewal for one year.
Renewal Application
Submit a signed renewal application and fee by December 31 preceding the renewal year.

Official no-examination sources

Effective from 2026-09-22.

Renewal or reissuance of suspended or revoked license within the renewal window
No examination is required for this applicant pathway.
Board Conditions
Satisfy every condition established by the Board for renewal or reissuance and pay the Board fee under 43-42-03(7). That provision does not identify an examination; an individualized Board order is an applicant condition.
Continuing Education
Demonstrate satisfactory completion of continuing study under 43-42-03(8) and the applicable requirements of 105-02-01-04.
Prior License
Previously licensed by the Board; license has been suspended or revoked.
Window
This route applies within the three-year renewal window without triggering entry-level recredentialing. Beyond that boundary, the new-application/recredentialing route applies.

Official no-examination sources

Effective from 2026-09-22.

Reissuance after suspension or revocation with three year lapse and new application
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Disciplinary Restoration
Satisfy the Board conditions imposed under 43-42-03(7), pay its reissuance fee, and demonstrate continuing study. The three-year lapse and new-application rules also apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
New application and entry level recredentialing after a three year license lapse
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Renewal Boundary
Under 105-02-01-02(4), an application after three years from the last issuance is a new application. Under 105-02-01-01(3), failure to maintain licensure for three years requires entry-level recredentialing. A registry credential remains required for the RRT license; applicant-specific Board conditions govern reliance on an existing registry credential.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).
Universal licensure under NDCC 43 51.1 02
Applicability
Applies unless the Board is part of an effective interstate compact, an executed license transfer, existing interstate mobility, or reciprocity agreement. Statutory reciprocity authority alone does not establish an executed agreement.
Application
Submit the signed and notarized Board application and prescribed fee. The Board may request additional information or clarification.
Background Check
The Board current initial instructions require a new statewide and nationwide criminal history record check, at applicant expense.
Board Fitness
The Board must find the applicant qualified and competent; the refusal and discipline grounds in 43-42-03(5) apply.
Competency
Demonstrate competency and education through methods determined by the Board; general initial-application NBRC qualification evidence is retained.
Criminal Check
Submit to a state and federal criminal background check if required by the Board with statutory authority, and pay established fees.
Discipline
No discipline in a jurisdiction in which licensed during the last ten years, and no active investigation by another licensing or disciplinary authority or law enforcement.
Disqualifying Acts
No act constituting grounds for refusal, suspension or revocation unless the Board determines it is not an impediment.
Education
Complete a bona fide respiratory care training program accredited by CoARC or its successor; supply an official transcript, certificate or diploma.
Education Documentation
The Board instructions require an official transcript sent directly by the school or a notarized diploma copy. The October 23, 2024 paper form additionally requests an Education Verification Form directly from the school.
License Verification
Supply verification from every jurisdiction in which presently or previously licensed; an official online-verification address may be supplied where that jurisdiction offers online verification only.
National Credential
Supply the NBRC certification certificate for CRT or registry certificate for RRT; official passing standards are those in effect when the examination was administered. Passing the currently offered examination before applying remains part of this route. An applicant holding a credential earned under an earlier examination supplies that historical evidence for Board assessment.
Out Of State License
Hold an out-of-state license with comparable requirements and actively have used it for two of the three years immediately preceding application.
Three Year Lapse
If a license has not been maintained for three years, entry-level recredentialing is required under 105-02-01-01(3).

Military Provisional License — Registered Respiratory Therapist

Statutory military provisional authorization under NDCC 43-51-11.1. The law allows a provisional license or temporary permit; form selection is made by the Board. Retained notwithstanding the lower-ranked general Board statement that ordinary provisional licensure is no longer offered. This is not an ordinary graduate temporary license.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Military provisional issuance on substantial compliance
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Duration
No longer than two years and valid only while making progress toward unmet requirements, subject to the statutory termination events.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.
Automatic military provisional issuance after thirty days without Board disposition
Automatic Duration
An automatic authorization remains valid until the Board grants or denies the application or issues a provisional license or temporary permit under subsection 2; subsection 5 states this distinct validity rule.
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Deadline
Thirty days after receipt of a completed military application, if the Board has neither granted nor denied the full license nor issued an authorization under subsection 2, it must automatically issue the provisional license or temporary permit.
Duration
Subsection 5 supplies the validity period for this automatic issuance; the two-year rule quoted from subsection 2 describes the replacement authorization issued under subsection 2.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.

Military Temporary Permit — Registered Respiratory Therapist

Statutory military provisional authorization under NDCC 43-51-11.1. The law allows a provisional license or temporary permit; form selection is made by the Board. Retained notwithstanding the lower-ranked general Board statement that ordinary provisional licensure is no longer offered. This is not an ordinary graduate temporary license.

Licensing authority: North Dakota State Board of Respiratory Care · Application information

Military provisional issuance on substantial compliance
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Duration
No longer than two years and valid only while making progress toward unmet requirements, subject to the statutory termination events.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.
Automatic military provisional issuance after thirty days without Board disposition
Automatic Duration
An automatic authorization remains valid until the Board grants or denies the application or issues a provisional license or temporary permit under subsection 2; subsection 5 states this distinct validity rule.
Board Statement
The general initial-application page states: "Provisional Licensure is no longer offered as of September 1, 2022! Only full licensure is offered." This lower-ranked general statement does not remove the mandatory military statutory authorization.
Competence And Safety
Substantially meet the statutory military competency and public-safety standards. Ordinary NBRC qualification requirements may be waived, deferred or remain unmet under the military licensing exception; the route references the currently offered examinations involved in the ordinary license being sought.
Deadline
Thirty days after receipt of a completed military application, if the Board has neither granted nor denied the full license nor issued an authorization under subsection 2, it must automatically issue the provisional license or temporary permit.
Duration
Subsection 5 supplies the validity period for this automatic issuance; the two-year rule quoted from subsection 2 describes the replacement authorization issued under subsection 2.
Fees
No fee for the provisional license or temporary permit under 43-51-11.1(2).
Form Selection
The statute permits a provisional license or temporary permit; it does not require applicants to obtain both forms.
Military Status
Qualify as a military spouse or military member and provide proof.
Termination
Ends on full-license grant or denial, expiry, failure to comply with permit terms, or revocation necessary to protect public health and safety.

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