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Oklahoma Respiratory Therapy — Requirements & Free Practice

US-OK · License preparation

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Licenses, application pathways and examination requirements

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

Provisional License

Six-month supervised provisional license for paid enrolled students, eligible graduates and licensees outside Oklahoma who do not qualify for endorsement.

Licensing authority: Oklahoma State Board of Medical Licensure and Supervision · Application information

Provisional licensure of education program graduates
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Duration
Six months, subject to renewal rules; renewal cannot extend more than one year after graduation.
Eligibility
Graduate from CoARC-approved or equivalent Board-approved respiratory care education; arrange direct education verification.
Examination
Applied to take the license examination; for an outside licensee, supply acceptance to sit for NBRC entry certification or all advanced registry examinations under 435:45-3-2(e)(4).
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
Supervision
Verified supervision by a consenting licensed respiratory care practitioner or physician.
Lapsed provisional renewal pending NBRC examination results
Lapse
Lapsed more than thirty days; Committee may require personal appearance under 435:45-5-2(b).
Renewal
Application and fee by last day of expiration month; six-month renewals, up to four, with no renewal more than one year after graduation.
Status
Verify acceptance to sit the NBRC examination or having sat and awaiting results; timing is a condition and the involved current exam remains a leaf.
Supervision
Continue verified supervision and authorized practice conditions.
Lapsed provisional renewal while enrolled
No examination is required for this applicant pathway.
Lapse
Lapsed more than thirty days; Committee may require personal appearance under 435:45-5-2(b).
Renewal
Application and fee by last day of expiration month; six-month renewals, up to four, with no renewal more than one year after graduation.
Status
Document current program enrollment.
Supervision
Continue verified supervision and authorized practice conditions.

Official no-examination sources

Effective from 2001-05-11.

Provisional licensure of outside licensees not qualifying for endorsement
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Duration
Six months, subject to renewal rules; renewal cannot extend more than one year after graduation.
Eligibility
Hold an outside respiratory care license but do not qualify for endorsement; show sworn current practice or practice in the last six months.
Examination
Applied to take the license examination; for an outside licensee, supply acceptance to sit for NBRC entry certification or all advanced registry examinations under 435:45-3-2(e)(4).
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
Supervision
Verified supervision by a consenting licensed respiratory care practitioner or physician.
Provisional renewal pending NBRC examination results
Lapse
Apply timely under 435:45-5-2(a).
Renewal
Application and fee by last day of expiration month; six-month renewals, up to four, with no renewal more than one year after graduation.
Status
Verify acceptance to sit the NBRC examination or having sat and awaiting results; timing is a condition and the involved current exam remains a leaf.
Supervision
Continue verified supervision and authorized practice conditions.
Provisional renewal while enrolled
No examination is required for this applicant pathway.
Lapse
Apply timely under 435:45-5-2(a).
Renewal
Application and fee by last day of expiration month; six-month renewals, up to four, with no renewal more than one year after graduation.
Status
Document current program enrollment.
Supervision
Continue verified supervision and authorized practice conditions.

Official no-examination sources

Effective from 2001-05-11.

Provisional licensure of paid enrolled students
No examination is required for this applicant pathway.
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Duration
Six-month term with discretionary renewals.
Enrollment
Currently enrolled in an approved respiratory technician or therapist program and receiving remuneration for respiratory care employment.
Proficiency
Program submits verified task competencies directly using PR Form 6. Only verified tasks may be performed; these curriculum evaluations are training conditions, not a separately established examination.
Supervision
Submit supervision verification by an Oklahoma licensed respiratory care practitioner or physician.

Official no-examination sources

Effective from 2013-11-01.

Respiratory Care Practitioner

Ordinary respiratory care license under 59 O.S. 2026–2045. Current evaluation precedes SB 1651 effective November 1, 2026. Special provisional issuance in 2035(B)(2) ended thirty-six months after November 1, 1995. The grandfather cohort in 2035(B)(1) has no stated application deadline. Section 493.5 defines volunteer-license eligible professions and does not include respiratory care. Universal recognition under 4150.1(B)(1) requires absence of Title 59 reciprocity or equivalency authority; respiratory care already has equivalency endorsement in 2033(B)(1).

Licensing authority: Oklahoma State Board of Medical Licensure and Supervision · Application information

Equivalent license endorsement
No examination is required for this applicant pathway.
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Discretion
Board evaluates equivalence; another jurisdiction examination and historical scores are applicant evidence, not this state route examination leaves.
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
License
Hold a current respiratory care license outside Oklahoma; the Board deems qualifications equivalent under 2033(B)(1). Certify credentials are not suspended or revoked under 2033(B)(3).
Practice
Practiced within the preceding twelve months, or already held an Oklahoma license; the never-licensed practice-gap rule is not engaged.
Temporary Practice
435:45-3-3 permits Secretary-authorized supervised temporary practice between acceptance of a completed application and license issuance; this permission is not an independently named license type.

Official no-examination sources

Effective from 2013-11-01.

Equivalent license endorsement after a practice gap
Therapist Multiple-Choice Examination
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Discretion
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
License
Hold a current respiratory care license outside Oklahoma; the Board deems qualifications equivalent under 2033(B)(1). Certify credentials are not suspended or revoked under 2033(B)(3).
Practice
Never held an Oklahoma license and did not practice within twelve months.
Temporary Practice
435:45-3-3 permits Secretary-authorized supervised temporary practice between acceptance of a completed application and license issuance; this permission is not an independently named license type.
Endorsement based on NBRC credentials
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Credential
Hold accepted NBRC credentials which are not suspended or revoked, provide oath and direct NBRC verification under 2033(B)(2)-(3) and 435:45-3-2(a).
Exam Alternatives
NBRC certification or advanced registry is accepted. The supplied frozen current examination references represent TMC certification, or TMC together with CSE for advanced registry; an applicant need not pursue both credential levels.
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
Historical Scores
A score from a no-longer-offered examination is prior credential evidence. Current examination references do not themselves require every credential holder to retake examinations.
Practice Gap
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Prior Pass
Currently offered examinations underlying the credentials remain leaves even when passed before applying.
Temporary Practice
435:45-3-3 permits Secretary-authorized supervised temporary practice between acceptance of a completed application and license issuance; this permission is not an independently named license type.
Grandfather licensure
No examination is required for this applicant pathway.
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Discretion
2035(B)(1) permits licensure without prior CRTT or RRT passing at Board discretion.
Experience
More than twenty-four months full-time respiratory care practice before November 1, 1995, demonstrated through sworn evidence certified by the employing health care facility.
Practice
Practiced within the preceding twelve months or previously held an Oklahoma license.
Practice Gap
The never-licensed practice-gap provision is not engaged.

Official no-examination sources

Effective from 1995-11-01.

Grandfather licensure after a practice gap
Therapist Multiple-Choice Examination
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Discretion
2035(B)(1) permits licensure without prior CRTT or RRT passing at Board discretion.
Experience
More than twenty-four months full-time respiratory care practice before November 1, 1995, demonstrated through sworn evidence certified by the employing health care facility.
Practice
Never held an Oklahoma license and did not practice in the previous twelve months.
Practice Gap
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Licensure by examination
Application
Submit the Allied Health application, required fees, all required documentation, and verification of licenses currently or previously held in medically related fields (435:45-3-1 and 3-2).
Education
Graduate from an approved respiratory care education program and arrange educational verification directly from the program under 435:45-3-2(c).
Exam Alternatives
NBRC certification or advanced registry is accepted. The supplied frozen current examination references represent TMC certification, or TMC together with CSE for advanced registry; an applicant need not pursue both credential levels.
Foreign Language
435:45-3-2(g) states TOEFL at least 560, TSE at least 50 and TWE at least 4.5 for foreign-educated therapists whose native language is not English; these language tests are conditions.
Historical Scores
A score from a no-longer-offered examination is prior credential evidence. Current examination references do not themselves require every credential holder to retake examinations.
Practice Gap
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Temporary Practice
435:45-3-3 permits Secretary-authorized supervised temporary practice between acceptance of a completed application and license issuance; this permission is not an independently named license type.
Expedited military equivalent license recognition
No examination is required for this applicant pathway.
Discretion
Never-licensed practice-gap retesting is not engaged.
Documentation
Board military page requests military ID, passport or birth certificate and DD-214, transfer notice/orders or honorable-discharge documentation.
Eligibility
Active-duty military personnel or spouse with a valid outside license and military transfer or honorable-discharge orders to Oklahoma; may apply before arrival under 4100.8(A).
Equivalence
Present satisfactory equivalent education, training and experience; outside license must be in good standing and reasonably equivalent; issuance within thirty days under 4100.8(B).
Fees
4100.8(D) waives application and first-period license fees for eligible active-duty personnel and spouse.
Limits
4100.7 preserves eligibility, testing and professional-history verification; equivalence is not an automatic blanket examination waiver.
Practice
Practiced within the preceding twelve months or previously held an Oklahoma license.

Official no-examination sources

Effective from 2019-11-01.

Expedited military equivalent license recognition after a practice gap
Therapist Multiple-Choice Examination
Discretion
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Documentation
Board military page requests military ID, passport or birth certificate and DD-214, transfer notice/orders or honorable-discharge documentation.
Eligibility
Active-duty military personnel or spouse with a valid outside license and military transfer or honorable-discharge orders to Oklahoma; may apply before arrival under 4100.8(A).
Equivalence
Present satisfactory equivalent education, training and experience; outside license must be in good standing and reasonably equivalent; issuance within thirty days under 4100.8(B).
Fees
4100.8(D) waives application and first-period license fees for eligible active-duty personnel and spouse.
Limits
4100.7 preserves eligibility, testing and professional-history verification; equivalence is not an automatic blanket examination waiver.
Practice
Never held an Oklahoma license and did not practice during the preceding twelve months.
Expedited military spouse endorsement
No examination is required for this applicant pathway.
Discretion
Never-licensed practice-gap retesting is not engaged.
Documentation
Board military page requests military ID, passport or birth certificate and DD-214, transfer notice/orders or honorable-discharge documentation.
Eligibility
License outside Oklahoma; spouse is active-duty US Armed Forces member transferred to Oklahoma; applicant left employment outside Oklahoma to accompany spouse under 4100.5(B).
Equivalence
Board finds qualifications substantially equivalent under 4100.5(C)(1).
Fees
Fees follow the applicable military licensing provision.
Limits
4100.7 preserves eligibility, testing and professional-history verification; equivalence is not an automatic blanket examination waiver.
Practice
Practiced within the preceding twelve months or previously held an Oklahoma license.

Official no-examination sources

Effective from 2018-11-01.

Expedited military spouse endorsement after a practice gap
Therapist Multiple-Choice Examination
Discretion
For applicants who never held an Oklahoma license and have not practiced within twelve months, 435:45-3-2(h) permits one or more of NBRC entry-level retesting, up to ninety days direct supervision with a performance report, and Committee appearance.
Documentation
Board military page requests military ID, passport or birth certificate and DD-214, transfer notice/orders or honorable-discharge documentation.
Eligibility
License outside Oklahoma; spouse is active-duty US Armed Forces member transferred to Oklahoma; applicant left employment outside Oklahoma to accompany spouse under 4100.5(B).
Equivalence
Board finds qualifications substantially equivalent under 4100.5(C)(1).
Fees
Fees follow the applicable military licensing provision.
Limits
4100.7 preserves eligibility, testing and professional-history verification; equivalence is not an automatic blanket examination waiver.
Practice
Never held an Oklahoma license and did not practice during the preceding twelve months.
Reactivation from inactive status
Therapist Multiple-Choice Examination
Inactive
Previously notified the Board of intent not to practice; no renewal notice or fee while inactive under 2037(D).
Retest
2037(D)(2) requires a Board-specified inactivity period for retesting. Published return-to-practice guidelines name NBRC entry-level retesting; retain it as a possible examination. The Committee determines the applicable supervision, education and appearance requirements.
Return To Practice
Notify the Board in writing of intent to resume; satisfy current requirements and remit renewal and reinstatement fees.
Re entry after a lapse exceeding twelve months
Therapist Multiple-Choice Examination
Application
File the Board re-entry application.
Discretion
435:45-3-5 permits Committee appearance, direct supervision for one month (at least twenty-two days) per year lapsed with a performance report, passing the NBRC entry-level examination, and Committee-determined continuing education.
Lapse
License lapsed more than twelve months.
Reinstatement after thirty days and within twelve months
Therapist Multiple-Choice Examination
Application
File the Board reinstatement application and required fees.
Discretion
435:45-3-4 permits one or more of Committee appearance, at least twelve CRCE, up to ninety days direct supervision with performance report, or passing the NBRC entry-level examination. The specifically identified examination is retained even if the Board excuses it.
Lapse
License lapsed more than thirty days but not more than twelve months; use 435:45-3-4 reinstatement application.
Reinstatement within thirty days
Therapist Multiple-Choice Examination
Application
File the Board reinstatement application and required fees.
Discretion
435:45-3-4 permits one or more of Committee appearance, at least twelve CRCE, up to ninety days direct supervision with performance report, or passing the NBRC entry-level examination. The specifically identified examination is retained even if the Board excuses it.
Lapse
Request is within thirty days of lapse; 2037(C) specifies renewal and reinstatement fees.
Biennial renewal
No examination is required for this applicant pathway.
Education
Twelve CRCE per biennium, at least half directly clinical; provide documentation on audit under 435:45-5-1.
Optional Credit
435:45-5-1(i) allows optional education credit for NBRC entry, advanced or recredentialing examinations. This is an education-credit mechanism, not a routine renewal examination requirement.
Renewal
Return notice and fee before expiry; renewal is biennial under 2037(A)-(B).

Official no-examination sources

Effective from 2010-08-26.

Clinical Simulation Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based clinical simulation examination of patient-management problems with information-gathering and decision-making sections; each section of each problem is classified to a minor content heading of the Detailed Content Outline. Admission requires the CRT and a TMC pass at the high cut score; with the implementation of the Respiratory Therapy Examination the CSE is available only to those who passed the TMC at the high cut score by December 31, 2026, and it ends December 31, 2027
Exam questions
22 problems: 20 scored and 2 pretest
Time limit
4 hours
Passing score
Points associated with the candidate’s set of responses are summed across the whole examination into one score compared with a cut score linked to examination committee decisions on whether each positively-scored option is required as a demonstration of minimal competence
Exam fee
$200 for both new and repeat applicants
Examination outline
  • I. PATIENT DATA
    • I.A. Evaluate Data in the Patient Record — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, Apgar scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, Apgar score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary exercise testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary exercise testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF EQUIPMENT, AND INFECTION CONTROL
    • II.A. Assemble /Troubleshoot Devices — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation device; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care Techniques in High-Risk Situations — 1. Emergency a. cardiopulmonary emergencies excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, EBUS, navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources

Therapist Multiple-Choice Examination

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