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Vermont Respiratory Therapy — Requirements & Free Practice

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Respiratory Care Practitioner License

License to practice respiratory care and use the title respiratory care practitioner (R.C.P.).

Licensing authority: Vermont Secretary of State, Office of Professional Regulation (Director, with Respiratory Care Practitioner Advisors) · Application information

Reinstatement of a revoked license
No examination is required for this applicant pathway.
Decision
The administrative law officer may reinstate a revoked license on terms and conditions the officer deems proper under § 4714(f).
Individual Order
Comply with the individual reinstatement order. The statutory route identifies no examination; an examination described only in an individual future order is not an identified current exam in this survey.

Official no-examination sources

Effective from 2026-09-22.

Licensure without examination by endorsement
No examination is required for this applicant pathway.
Application
Apply online and pay the nonrefundable application fee.
Board Certification Request
Although § 4709(a) authorizes endorsement without examination, the February 2026 OPR application instructions state: Apply by Endorsement Applicants who are licensed or certified in another jurisdiction where the qualifications are substantially equivalent to Vermont's requirements.  Submit an online application and pay the non-refundable application fee. Applications are found within the online services system.  Request an official verification of license be sent to OPR for your initial state of licensure and most recent state of licensure. This must be sent directly from the licensing authority and can be sent by email or by US mail. It is not required that the other state complete the Vermont verification form. Online verification is acceptable and must be uploaded by the applicant.  Upload Official Verification of NBRC Certification. An applicant must contact NBRC directly by calling 888-341-4811 or visit NBRC website.
License Held
Hold a current respiratory care license in good standing in another state, territory, or country; the Director must determine the applicable standards and qualifications are at least equal to Vermont requirements under § 4709(a).
No New Exam
The controlling endorsement statute and Rule 2.4 authorize licensure without examination. The lower-ranked application request for NBRC certification is retained here as an applicant condition.
Verification
Provide official verification from the initial and most recent licensing jurisdictions; the OPR instructions permit uploaded online verification.

Official no-examination sources

Effective from 2026-09-22.

Licensure by examination
Application
Apply through OPR online services and pay the nonrefundable application fee.
Certification Alternatives
The state university licensure disclosure identifies CRT earned through TMC and RRT earned through TMC at the high cut score plus CSE. TMC alone is the CRT alternative; CSE is involved in the RRT alternative. The university disclosure is read together with the statute and current OPR NBRC certification requirement.
Education
Complete a respiratory care educational program accredited by CoARC or CAAHEP, or a successor organization, as required by 26 V.S.A. §§ 4701(10) and 4707(1).
Failed Examination
Rule 2.3(b) states that candidates who fail the approved examination must retake it and are ineligible to practice until successful completion.
Historical Education Statement
The 2005 administrative Rule 2.3(a) says: accreditation of allied health education programs, or their successor organizations. This does not apply to applicants who passed the examination and were conferred credentials prior to July 31, 1977. The current controlling statute, 26 V.S.A. § 4707(1), requires completion of the defined educational program; § 4715 records repeal of the historical grandfather provision.
Military Training
OPR recognizes qualifying military education, training, and service toward professional licensing requirements under 3 V.S.A. § 123(g). Active service members, veterans discharged within two years, and active-duty spouses may submit the OPR military affidavit for expedited processing, with the requested military documentation.
Nbrc Verification
Upload official verification of NBRC certification under the February 2026 OPR instructions.
Reinstatement after extended absence with demonstrated competence
No examination is required for this applicant pathway.
Absence
Five or more years of absence from practice; § 4713(e) additionally addresses a license lapsed for more than five consecutive years.
Competence Evidence
The Director may require documented licensed practice elsewhere, remedial coursework, or continuing education under § 4713(e)(1)-(3).
Director Determination
The Director determines retention of the required competencies under 3 V.S.A. § 135(b)(1); this route is for applicants whose competence is accepted without reexamination or new application.
Fees
Pay applicable current renewal, late, and reinstatement fees; lapsed-year renewal fees are not required.

Official no-examination sources

Effective from 2026-09-22.

Reapplication as a new applicant after extended absence
Absence
Five or more years of absence from practice.
Application
Apply through OPR online services and pay the nonrefundable application fee.
Certification Alternatives
The state university licensure disclosure identifies CRT earned through TMC and RRT earned through TMC at the high cut score plus CSE. TMC alone is the CRT alternative; CSE is involved in the RRT alternative. The university disclosure is read together with the statute and current OPR NBRC certification requirement.
Director Determination
This route applies when the Director determines that competencies have not been retained and requires reapplication in like manner to a new applicant under 3 V.S.A. § 135(b)(2).
Education
Complete a respiratory care educational program accredited by CoARC or CAAHEP, or a successor organization, as required by 26 V.S.A. §§ 4701(10) and 4707(1).
Failed Examination
Rule 2.3(b) states that candidates who fail the approved examination must retake it and are ineligible to practice until successful completion.
Historical Education Statement
The 2005 administrative Rule 2.3(a) says: accreditation of allied health education programs, or their successor organizations. This does not apply to applicants who passed the examination and were conferred credentials prior to July 31, 1977. The current controlling statute, 26 V.S.A. § 4707(1), requires completion of the defined educational program; § 4715 records repeal of the historical grandfather provision.
Military Training
OPR recognizes qualifying military education, training, and service toward professional licensing requirements under 3 V.S.A. § 123(g). Active service members, veterans discharged within two years, and active-duty spouses may submit the OPR military affidavit for expedited processing, with the requested military documentation.
Nbrc Verification
Upload official verification of NBRC certification under the February 2026 OPR instructions.
New Applicant Requirements
The current examination and certification alternatives for new applicants apply; whether the Director instead accepts other evidence is an individual condition.
Fast Track Endorsement
No examination is required for this applicant pathway.
Application
Submit an online application and pay the application fee.
Licensure
Actively licensed or certified in good standing in another United States jurisdiction for three or more years immediately preceding the application.
Practice Waiver
Under 3 V.S.A. § 136a(c), the Director may waive the profession’s practice requirement if consistent with State policy and public protection.
Verification
Request verification sent directly to OPR establishing three continuous years in good standing.

Official no-examination sources

Effective from 2026-09-22.

Licensure by examination for foreign trained graduates
Application
Apply through OPR online services and pay the nonrefundable application fee.
Certification Alternatives
The state university licensure disclosure identifies CRT earned through TMC and RRT earned through TMC at the high cut score plus CSE. TMC alone is the CRT alternative; CSE is involved in the RRT alternative. The university disclosure is read together with the statute and current OPR NBRC certification requirement.
Credential Review
OPR evaluates the academic credentials submitted with the completed application in consultation with a credentials evaluation service. The applicant pays the review cost and must use the current acceptable services and steps supplied by OPR under Rule 2.7.
Education
Foreign-trained applicants must have completed a respiratory care educational program equivalent to accredited-school standards under Rule 2.7.
Failed Examination
Rule 2.3(b) states that candidates who fail the approved examination must retake it and are ineligible to practice until successful completion.
Historical Education Statement
The 2005 administrative Rule 2.3(a) says: accreditation of allied health education programs, or their successor organizations. This does not apply to applicants who passed the examination and were conferred credentials prior to July 31, 1977. The current controlling statute, 26 V.S.A. § 4707(1), requires completion of the defined educational program; § 4715 records repeal of the historical grandfather provision.
Military Training
OPR recognizes qualifying military education, training, and service toward professional licensing requirements under 3 V.S.A. § 123(g). Active service members, veterans discharged within two years, and active-duty spouses may submit the OPR military affidavit for expedited processing, with the requested military documentation.
Nbrc Verification
Upload official verification of NBRC certification under the February 2026 OPR instructions.
Expedited endorsement for a transferred military spouse
No examination is required for this applicant pathway.
Affidavit
Attach the OPR military affidavit to the license application and provide the transfer orders and military ID requested by the affidavit.
Application
Apply online and pay the nonrefundable application fee.
Board Certification Request
Although § 4709(a) authorizes endorsement without examination, the February 2026 OPR application instructions state: Apply by Endorsement Applicants who are licensed or certified in another jurisdiction where the qualifications are substantially equivalent to Vermont's requirements.  Submit an online application and pay the non-refundable application fee. Applications are found within the online services system.  Request an official verification of license be sent to OPR for your initial state of licensure and most recent state of licensure. This must be sent directly from the licensing authority and can be sent by email or by US mail. It is not required that the other state complete the Vermont verification form. Online verification is acceptable and must be uploaded by the applicant.  Upload Official Verification of NBRC Certification. An applicant must contact NBRC directly by calling 888-341-4811 or visit NBRC website.
License Held
Hold a current respiratory care license in good standing in another state, territory, or country; the Director must determine the applicable standards and qualifications are at least equal to Vermont requirements under § 4709(a).
Military Spouse
The applicant is licensed in good standing elsewhere, accompanies a spouse transferred to Vermont by the U.S. Armed Forces, and left employment to accompany the spouse, as specified in 3 V.S.A. § 123(g)(1)(B).
No New Exam
The controlling endorsement statute and Rule 2.4 authorize licensure without examination. The lower-ranked application request for NBRC certification is retained here as an applicant condition.
Processing
OPR provides expedited processing on a case-by-case basis; the underlying endorsement qualifications remain applicable.
Verification
Provide official verification from the initial and most recent licensing jurisdictions; the OPR instructions permit uploaded online verification.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement following fewer than five years of absence
No examination is required for this applicant pathway.
Absence
Fewer than five years of absence from practice.
Fees
Pay the current renewal fee and late fee; no renewal fees are due for lapsed years.
Readiness
Readiness is inferred from continuing education that would have been required during continuous licensure, or a less burdensome showing permitted by profession-specific rules or the Director under 3 V.S.A. § 135(a).

Official no-examination sources

Effective from 2026-09-22.

Biennial renewal
No examination is required for this applicant pathway.
Application
Renew online before expiration and pay the renewal fee.
Continuing Education
Complete 12 hours of Director-approved continuing education in the preceding two-year period. The current OPR instructions request AARC- or NBRC-approved continuing education and state six hours for a first renewal after more than one but less than two years of licensure.
Education Waivers
Rule 3.3(b) permits an extension or waiver for documented extenuating circumstances; the applicant must request it from the Director.
First Year
Rule 3.2(b) states that no continuing education is required if the initial license has been held for one year or less.
Optional Recredentialing
Rule 3.2(c)(1) accepts unspecified NBRC recredentialing examinations as one form of continuing education; no examination is required for this renewal route.

Official no-examination sources

Effective from 2026-09-22.

Restoration following reversal of an administrative rescission
No examination is required for this applicant pathway.
Existing Qualifications
This restores the license that was rescinded; it is not a new examination-based issuance.
Initial Review
For a license active for less than 30 days, seek review of the rescission; the Director bears the burden, and a reversed rescission results in immediate reinstatement under 3 V.S.A. § 129c(b)(1)(C).
Later Review
For a license active for 30 days or more, elect a hearing within 30 days of notice; a resulting decision may reverse the rescission under § 129c(b)(2).

Official no-examination sources

Effective from 2026-09-22.

Temporary Respiratory Care Practitioner License

Temporary practice authorization pending examination or completion of endorsement verification; current application instructions call the verification-pending authorization a 90-day provisional license.

Licensing authority: Vermont Secretary of State, Office of Professional Regulation (Director, with Respiratory Care Practitioner Advisors) · Application information

Temporary or provisional authorization pending endorsement verification
No examination is required for this applicant pathway.
Duration
Rule 2.5 permits up to 100 days; the current February 2026 instructions offer a 90-day provisional license while OPR awaits license verification.
Eligibility
The ordinary endorsement qualifications are met; only validation of out-of-state licensure remains outstanding.
Nbrc Verification
The implementing ordinary-endorsement instructions request official NBRC certification as an applicant condition despite the statute’s examination-free endorsement authority.
Supervision
A supervisor-of-record form must be on file, and practice is under indirect supervision and responsibility of a Vermont-licensed practitioner.

Official no-examination sources

Effective from 2026-09-22.

Exceptional renewal of temporary licensure
No examination is required for this applicant pathway.
Limits
The Director determines the authorized period; existing supervision and temporary-practice restrictions continue.
Petition
Petition the Director and show good and exceptional cause for renewal under § 4710(c) and the April 2026 verification instructions.
Subsequent Full License
This route renews the interim authorization itself. Subsequent examination-based full licensure is represented by its separate issuance route.

Official no-examination sources

Effective from 2026-09-22.

Provisional authorization pending Fast Track Endorsement verification
No examination is required for this applicant pathway.
Duration
The February 2026 OPR application instructions offer a 90-day provisional license while license verification is awaited.
Eligibility
Meet the Fast Track Endorsement criteria; verification of licensure is the only outstanding deficiency.
Supervision
The respiratory care temporary endorsement statute requires the supervisor-of-record form and indirect supervision by a Vermont-licensed respiratory care practitioner.

Official no-examination sources

Effective from 2026-09-22.

Temporary licensure pending the next examination
Certification
Full licensure requires the OPR NBRC certification verification; TMC yields CRT, and the RRT alternative additionally involves CSE.
Duration
The Director assigns the period; the April 2026 verification form states up to 100 days for temporary licenses.
Education
Complete the qualifying respiratory care education program.
Examination Timing
The temporary authorization lasts until the applicant takes the next Director-provided examination and a determination of qualification is made under § 4710(b)(1). The examination belongs in the route even though temporary issuance precedes it.
Initial Applicant
A person applying for the first time in Vermont who has the other qualifications of § 4707 may receive temporary licensure under § 4710(a).
Supervision
Practice is under the direction of a Vermont-licensed respiratory care practitioner; the April 2026 employment form requires daily, direct, on-site supervision for a post-graduate student by a Vermont practitioner with at least two years of experience.
Supervisor Form
Submit the current supervisor-of-record employment verification.

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