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West Virginia Respiratory Therapy — Requirements & Free Practice

US-WV · License preparation

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Licensed Respiratory Therapist Certified (LRTC)

Certified-level respiratory care license. Inactive status and disciplinary limitations are statuses of this license, not independently issued professional identities.

Licensing authority: West Virginia Board of Respiratory Care · Application information

Annual renewal
No examination is required for this applicant pathway.
Continuing education
Accrue and report twenty relevant approved CEUs per two-year cycle. CEUs are applicant continuing education conditions; optional examinations in 30CSR3 §4.5 are methods of earning CE credit, not mandatory professional licensure examinations.
Current license
Renew the existing LRTC license before January 1; renewal runs November 1 through December 31, with the published fee and timely CE reporting.
Discipline
Renewal remains subject to statutory denial grounds and any individually imposed disciplinary terms.
Nbrc status
The Board’s March 16, 2011 position explicitly says it no longer requires maintaining active NBRC credentials for license renewal; employers may set their own conditions.

Official no-examination sources

Effective from 2026-09-22.

Discretionary reinstatement after suspension or revocation
No examination is required for this applicant pathway.
Board discretion
W. Va. Code §30-1-8a permits the Board to consider reinstatement of a suspended or revoked license upon a showing of reasonable skill and safety; approval is case-specific.
Fitness
Under 30CSR4 §3.2.7 the Board may require an approved practitioner’s physical or psychological examination after probable cause. Medical fitness evidence and individualized Board discretion are conditions.
Order terms
Comply with the disciplinary or consent order and pay applicable reinstatement or monitoring costs under 30CSR4 §4.6. No named currently offered professional examination is prescribed by this administrative restoration procedure.
Separate expiration
If the license also expired, the expired-license route and its NBRC credential requirements apply separately.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement of an expired license (after five years)
Therapist Multiple-Choice Examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Expiration window
License expired more than five years ago; §30-34-7(b) requires compliance with original-license issuance provisions.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Reinstatement credential
30CSR1 §4.1 requires proof of a current valid CRT or RRT credential within a year of application and completion of Board-set CE requirements. Restore at the selected certified or registered practice level; the national examinations remain leaves even if originally passed before the application.
Rule text disagreement
30CSR1 §3.1.2 says: "Holds a current valid Registered Respiratory Therapist Credential conferred by the National Board of Respiratory Care or its successor organizations." Section 3.1.3 instead accepts CRT or RRT. W. Va. Code §30-34-8(a) accepts certification or registration, and §30-34-12(a) expressly establishes the certified designation after the entry-level examination. This route follows that higher-ranked statutory certified boundary; the Board home page also states that either CRT or RRT qualifies after May 1, 2025. The additional RRT wording is retained here for the applicant.
Unfulfilled education
Any CE requirement not fulfilled at expiration must be completed and accompany the reinstatement application; supply documents through the reinstatement form or wizard.
Reinstatement of an expired license (within five years)
Therapist Multiple-Choice Examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Expiration window
License expired no more than five years ago; §30-34-7(b) permits renewal on Board requirements and initial-license fee.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Reinstatement credential
30CSR1 §4.1 requires proof of a current valid CRT or RRT credential within a year of application and completion of Board-set CE requirements. Restore at the selected certified or registered practice level; the national examinations remain leaves even if originally passed before the application.
Rule text disagreement
30CSR1 §3.1.2 says: "Holds a current valid Registered Respiratory Therapist Credential conferred by the National Board of Respiratory Care or its successor organizations." Section 3.1.3 instead accepts CRT or RRT. W. Va. Code §30-34-8(a) accepts certification or registration, and §30-34-12(a) expressly establishes the certified designation after the entry-level examination. This route follows that higher-ranked statutory certified boundary; the Board home page also states that either CRT or RRT qualifies after May 1, 2025. The additional RRT wording is retained here for the applicant.
Unfulfilled education
Any CE requirement not fulfilled at expiration must be completed and accompany the reinstatement application; supply documents through the reinstatement form or wizard.
Placement on inactive status
No examination is required for this applicant pathway.
Current license
Currently hold this West Virginia respiratory care license and provide written notice to the Board.
Fees and education
Statute §30-34-7(c) exempts fees while inactive. The Board may waive CE requirements under 30CSR3 §9.3. This is a status of the existing license.
Practice cessation
Cease respiratory care practice in West Virginia; inactive status cannot exceed five years.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure by certification or registration examination
Therapist Multiple-Choice Examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Rule text disagreement
30CSR1 §3.1.2 says: "Holds a current valid Registered Respiratory Therapist Credential conferred by the National Board of Respiratory Care or its successor organizations." Section 3.1.3 instead accepts CRT or RRT. W. Va. Code §30-34-8(a) accepts certification or registration, and §30-34-12(a) expressly establishes the certified designation after the entry-level examination. This route follows that higher-ranked statutory certified boundary; the Board home page also states that either CRT or RRT qualifies after May 1, 2025. The additional RRT wording is retained here for the applicant.
Endorsement of an existing license from another jurisdiction
Therapist Multiple-Choice Examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Board equivalence discretion
Equivalence is a Board determination. The current application requires NBRC credential documentation; an individual applicant’s equivalent qualifications or any waiver is recorded as a condition and does not remove the currently registered examinations the implementing requirement identifies.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Existing jurisdiction license
Hold a current respiratory care license from another jurisdiction; Board must consider qualifications equivalent to or greater than West Virginia requirements. Send official license verification directly from the issuing authority (W. Va. Code §30-34-8(b); 30CSR1 §3.2). Another jurisdiction’s own examination or another country’s national examination is applicant evidence, never a West Virginia leaf.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Rule text disagreement
30CSR1 §3.1.2 says: "Holds a current valid Registered Respiratory Therapist Credential conferred by the National Board of Respiratory Care or its successor organizations." Section 3.1.3 instead accepts CRT or RRT. W. Va. Code §30-34-8(a) accepts certification or registration, and §30-34-12(a) expressly establishes the certified designation after the entry-level examination. This route follows that higher-ranked statutory certified boundary; the Board home page also states that either CRT or RRT qualifies after May 1, 2025. The additional RRT wording is retained here for the applicant.
Endorsement of a current NBRC credential
Therapist Multiple-Choice Examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Endorsement basis
Board may endorse a currently valid NBRC credential under W. Va. Code §30-34-8(c); certify under oath that it has not been suspended or revoked. Education and application documents are the Board implementing demands; this route is distinguished from the education-and-examination route by its existing NBRC credential.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Rule text disagreement
30CSR1 §3.1.2 says: "Holds a current valid Registered Respiratory Therapist Credential conferred by the National Board of Respiratory Care or its successor organizations." Section 3.1.3 instead accepts CRT or RRT. W. Va. Code §30-34-8(a) accepts certification or registration, and §30-34-12(a) expressly establishes the certified designation after the entry-level examination. This route follows that higher-ranked statutory certified boundary; the Board home page also states that either CRT or RRT qualifies after May 1, 2025. The additional RRT wording is retained here for the applicant.
Return from inactive status
No examination is required for this applicant pathway.
Continuing education
Show five CEUs completed in the twelve months before applying; alternatively, request immediate return and agree to complete ten CEUs within twelve months after Board approval (30CSR3 §9.3).
Inactive license
Existing inactive status under §30-34-7(c) must be within its five-year limit. Apply for renewal and pay the current-year renewal fee before resuming practice.
Longer lapse
If the license instead expired, the expired-license reinstatement route governs.
Nbrc status
The Board’s renewal position does not require maintained active NBRC credentials.

Official no-examination sources

Effective from 2026-09-22.

Universal recognition without examination (military spouse)
No examination is required for this applicant pathway.
Board application demand
The general Board application requires an education certificate and an NBRC credential certificate or statement. These are retained as Board application demands; the overriding statute expressly grants this same-level universal route without examination.
Discipline and criminal history
No revocation or surrender during an investigation; prior discipline must have been corrected and fully resolved to the Board’s satisfaction; unresolved discipline delays action. No disqualifying criminal history; required background checks remain applicable under §30-1-27(f)(3).
Eligibility
Be married to an active-duty United States armed forces member and accompany that member on an official permanent change of station to a military installation in West Virginia.
Existing license
Hold a current license or certification in at least one other state in the same discipline and at the same practice level; all such licenses must be in good standing. The Board determines the same practice level and verifies the prior state’s minimum education and applicable experience and supervision standards.
Fees
Pay applicable state fees, subject to an applicable statutory waiver.
Practice limits
License is valid only in West Virginia and does not confer an interstate compact privilege (§30-1-27(g)).
Prior examinations
W. Va. Code §30-1-27(b)(5) requires any written or clinical examinations required by the prior licensing state to have been passed; the provision names no NBRC examination. Those unspecified prior-state examinations are applicant evidence, rather than invented exam leaves.
State law exam permission
Section 30-1-27(d) permits an existing Board state-law examination, but no such examination is identified in this profession’s actual implementing requirements. The clause creates no examination identity.

Official no-examination sources

Effective from 2026-09-22.

Universal recognition without examination (resident)
No examination is required for this applicant pathway.
Board application demand
The general Board application requires an education certificate and an NBRC credential certificate or statement. These are retained as Board application demands; the overriding statute expressly grants this same-level universal route without examination.
Discipline and criminal history
No revocation or surrender during an investigation; prior discipline must have been corrected and fully resolved to the Board’s satisfaction; unresolved discipline delays action. No disqualifying criminal history; required background checks remain applicable under §30-1-27(f)(3).
Eligibility
Establish residence in West Virginia.
Existing license
Hold a current license or certification in at least one other state in the same discipline and at the same practice level; all such licenses must be in good standing. The Board determines the same practice level and verifies the prior state’s minimum education and applicable experience and supervision standards.
Fees
Pay applicable state fees, subject to an applicable statutory waiver.
Practice limits
License is valid only in West Virginia and does not confer an interstate compact privilege (§30-1-27(g)).
Prior examinations
W. Va. Code §30-1-27(b)(5) requires any written or clinical examinations required by the prior licensing state to have been passed; the provision names no NBRC examination. Those unspecified prior-state examinations are applicant evidence, rather than invented exam leaves.
State law exam permission
Section 30-1-27(d) permits an existing Board state-law examination, but no such examination is identified in this profession’s actual implementing requirements. The clause creates no examination identity.

Official no-examination sources

Effective from 2026-09-22.

Licensed Respiratory Therapist Registered (LRTR)

Registered-level respiratory care license. An LRTC licensee can upgrade after earning the RRT credential. Inactive status and disciplinary limitations are statuses of this license.

Licensing authority: West Virginia Board of Respiratory Care · Application information

Annual renewal
No examination is required for this applicant pathway.
Continuing education
Accrue and report twenty relevant approved CEUs per two-year cycle. CEUs are applicant continuing education conditions; optional examinations in 30CSR3 §4.5 are methods of earning CE credit, not mandatory professional licensure examinations.
Current license
Renew the existing LRTR license before January 1; renewal runs November 1 through December 31, with the published fee and timely CE reporting.
Discipline
Renewal remains subject to statutory denial grounds and any individually imposed disciplinary terms.
Nbrc status
The Board’s March 16, 2011 position explicitly says it no longer requires maintaining active NBRC credentials for license renewal; employers may set their own conditions.

Official no-examination sources

Effective from 2026-09-22.

Discretionary reinstatement after suspension or revocation
No examination is required for this applicant pathway.
Board discretion
W. Va. Code §30-1-8a permits the Board to consider reinstatement of a suspended or revoked license upon a showing of reasonable skill and safety; approval is case-specific.
Fitness
Under 30CSR4 §3.2.7 the Board may require an approved practitioner’s physical or psychological examination after probable cause. Medical fitness evidence and individualized Board discretion are conditions.
Order terms
Comply with the disciplinary or consent order and pay applicable reinstatement or monitoring costs under 30CSR4 §4.6. No named currently offered professional examination is prescribed by this administrative restoration procedure.
Separate expiration
If the license also expired, the expired-license route and its NBRC credential requirements apply separately.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement of an expired license (after five years)
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Expiration window
License expired more than five years ago; §30-34-7(b) requires compliance with original-license issuance provisions.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Reinstatement credential
30CSR1 §4.1 requires proof of a current valid CRT or RRT credential within a year of application and completion of Board-set CE requirements. Restore at the selected certified or registered practice level; the national examinations remain leaves even if originally passed before the application.
Unfulfilled education
Any CE requirement not fulfilled at expiration must be completed and accompany the reinstatement application; supply documents through the reinstatement form or wizard.
Reinstatement of an expired license (within five years)
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Expiration window
License expired no more than five years ago; §30-34-7(b) permits renewal on Board requirements and initial-license fee.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Reinstatement credential
30CSR1 §4.1 requires proof of a current valid CRT or RRT credential within a year of application and completion of Board-set CE requirements. Restore at the selected certified or registered practice level; the national examinations remain leaves even if originally passed before the application.
Unfulfilled education
Any CE requirement not fulfilled at expiration must be completed and accompany the reinstatement application; supply documents through the reinstatement form or wizard.
Placement on inactive status
No examination is required for this applicant pathway.
Current license
Currently hold this West Virginia respiratory care license and provide written notice to the Board.
Fees and education
Statute §30-34-7(c) exempts fees while inactive. The Board may waive CE requirements under 30CSR3 §9.3. This is a status of the existing license.
Practice cessation
Cease respiratory care practice in West Virginia; inactive status cannot exceed five years.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure by certification or registration examination
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Endorsement of an existing license from another jurisdiction
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Board equivalence discretion
Equivalence is a Board determination. The current application requires NBRC credential documentation; an individual applicant’s equivalent qualifications or any waiver is recorded as a condition and does not remove the currently registered examinations the implementing requirement identifies.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Existing jurisdiction license
Hold a current respiratory care license from another jurisdiction; Board must consider qualifications equivalent to or greater than West Virginia requirements. Send official license verification directly from the issuing authority (W. Va. Code §30-34-8(b); 30CSR1 §3.2). Another jurisdiction’s own examination or another country’s national examination is applicant evidence, never a West Virginia leaf.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Endorsement of a current NBRC credential
Application and fee
Complete the signed application, supply government photo identification, and pay the $200 initial fee; an application incomplete after ninety days is abandoned. Statutory initial-fee waivers for qualifying low-income individuals and military families are applicant conditions.
Approved education
Provide an official transcript or diploma showing completion of a Board-approved respiratory care educational program (W. Va. Code §30-34-8(a)(1); 30CSR1 §3.1.1; Board application).
Approved exam slot
W. Va. Code §30-34-8(a)(2) and 30CSR1 §3.1.4 also permit examinations administered by the state or a Board-approved national agency and a Board-set passing score. No separately identifiable state examination is named by that permission; any individually approved equivalence is a Board decision condition.
Continuing education
The application page requires five CEUs with the application and fifteen additional CEUs within thirty days of licensure. The Board home page exempts new graduates from the initial five CEUs.
Criminal history
Initial licensure requires fingerprints and a state and national criminal history check, effective June 12, 2026, under W. Va. Code §30-34-6b; applicant pays the actual costs. A criminal conviction is evaluated under W. Va. Code §30-1-24 and 30CSR10 rather than creating a separate examination route.
Current nbrc credential
Provide the original NBRC credential certificate or official statement of credentials: CRT for LRTC, RRT for LRTR; statutory credential endorsement requires an oath that it has not been suspended or revoked. The existing passing examinations remain leaves even when taken before applying.
Endorsement basis
Board may endorse a currently valid NBRC credential under W. Va. Code §30-34-8(c); certify under oath that it has not been suspended or revoked. Education and application documents are the Board implementing demands; this route is distinguished from the education-and-examination route by its existing NBRC credential.
Fitness or restrictions
Applicants and licensees remain subject to Board discipline and individually imposed practice limitations. Under 30CSR4 §3.2.7 the Board may require a physician physical or psychological examination after probable cause; that examination is evidence of fitness, not a professional licensure examination.
Five year nonpractice
Board application states: "If you have not practiced in the preceding five (5) years, this board requires that you retake and pass the National Board of Respiratory Care examination." The nonpractice trigger is an applicant condition; no independent unnamed state exam is created.
Return from inactive status
No examination is required for this applicant pathway.
Continuing education
Show five CEUs completed in the twelve months before applying; alternatively, request immediate return and agree to complete ten CEUs within twelve months after Board approval (30CSR3 §9.3).
Inactive license
Existing inactive status under §30-34-7(c) must be within its five-year limit. Apply for renewal and pay the current-year renewal fee before resuming practice.
Longer lapse
If the license instead expired, the expired-license reinstatement route governs.
Nbrc status
The Board’s renewal position does not require maintained active NBRC credentials.

Official no-examination sources

Effective from 2026-09-22.

Universal recognition without examination (military spouse)
No examination is required for this applicant pathway.
Board application demand
The general Board application requires an education certificate and an NBRC credential certificate or statement. These are retained as Board application demands; the overriding statute expressly grants this same-level universal route without examination.
Discipline and criminal history
No revocation or surrender during an investigation; prior discipline must have been corrected and fully resolved to the Board’s satisfaction; unresolved discipline delays action. No disqualifying criminal history; required background checks remain applicable under §30-1-27(f)(3).
Eligibility
Be married to an active-duty United States armed forces member and accompany that member on an official permanent change of station to a military installation in West Virginia.
Existing license
Hold a current license or certification in at least one other state in the same discipline and at the same practice level; all such licenses must be in good standing. The Board determines the same practice level and verifies the prior state’s minimum education and applicable experience and supervision standards.
Fees
Pay applicable state fees, subject to an applicable statutory waiver.
Practice limits
License is valid only in West Virginia and does not confer an interstate compact privilege (§30-1-27(g)).
Prior examinations
W. Va. Code §30-1-27(b)(5) requires any written or clinical examinations required by the prior licensing state to have been passed; the provision names no NBRC examination. Those unspecified prior-state examinations are applicant evidence, rather than invented exam leaves.
State law exam permission
Section 30-1-27(d) permits an existing Board state-law examination, but no such examination is identified in this profession’s actual implementing requirements. The clause creates no examination identity.

Official no-examination sources

Effective from 2026-09-22.

Universal recognition without examination (resident)
No examination is required for this applicant pathway.
Board application demand
The general Board application requires an education certificate and an NBRC credential certificate or statement. These are retained as Board application demands; the overriding statute expressly grants this same-level universal route without examination.
Discipline and criminal history
No revocation or surrender during an investigation; prior discipline must have been corrected and fully resolved to the Board’s satisfaction; unresolved discipline delays action. No disqualifying criminal history; required background checks remain applicable under §30-1-27(f)(3).
Eligibility
Establish residence in West Virginia.
Existing license
Hold a current license or certification in at least one other state in the same discipline and at the same practice level; all such licenses must be in good standing. The Board determines the same practice level and verifies the prior state’s minimum education and applicable experience and supervision standards.
Fees
Pay applicable state fees, subject to an applicable statutory waiver.
Practice limits
License is valid only in West Virginia and does not confer an interstate compact privilege (§30-1-27(g)).
Prior examinations
W. Va. Code §30-1-27(b)(5) requires any written or clinical examinations required by the prior licensing state to have been passed; the provision names no NBRC examination. Those unspecified prior-state examinations are applicant evidence, rather than invented exam leaves.
State law exam permission
Section 30-1-27(d) permits an existing Board state-law examination, but no such examination is identified in this profession’s actual implementing requirements. The clause creates no examination identity.

Official no-examination sources

Effective from 2026-09-22.

Upgrade from LRTC to LRTR
Existing license
Hold a West Virginia LRTC license.
Fee and application
Submit the Board’s Upgrade request and pay the $10 upgrade fee.
Practice level
The upgrade results in the registered practice-level identity, rather than an additional independent state exam.
Rrt credential
Earn the NBRC RRT credential and upload the credential certificate or registry score sheets; both current registered national examinations leading to RRT remain leaves even if TMC was passed earlier for CRT.

Therapist Multiple-Choice Examination

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

Clinical Simulation Examination

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