The NBRC NPS exam, explained

Sheet

The NPS exam on one sheet

Sources: NBRC NPS exam page, NBRC Candidate Handbook (Sept 2026), NPS Detailed Content Outline (Oct 2025). Checked October 2026.

Two lines on that sheet change how you sit the exam. The first is the clock: 4 hours for 170 items works out to about 85 seconds an item, and you have to pace for all 170. The 20 pretest items look exactly like the scored ones, so three minutes lost on a pretest item costs you the same as three minutes on a scored one.

The second is the form. Nobody gets your exact set of items: each candidate's form is assembled to the same specification from groups of items. A colleague's list of what came up tells you which topics to expect, never which questions.

DCO

Section I and Section II: where the 150 scored items sit

The Detailed Content Outline effective October 1, 2025 splits the scored items into two content sections. Section I, competencies shared between critical and general care, carries 80 of the 150 scored items. Section II, critical care only, carries 70 of the 150 scored items.

Section I: shared care, 80 items over 13 areas

Section I is wide and shallow. Its largest area, I-A Assess Information, is 12 items; airway management (I-D), equipment selection and troubleshooting (I-E), medications (I-G) and diagnostic results (I-H) sit at 9 each. The tail is cheap to cover and easy to forget: procedures (I-F), resuscitation (I-J) and patient and family education (I-M) are 3 items each, nutrition (I-I) is 2. Read those small areas once before test day rather than hoping they miss your form. Area by area: the Section I guide.

Section II: critical care, 70 items, one dominant area

Section II has the opposite shape. II-C Manage Ventilation and Oxygenation is 30 items on its own, one in five scored items on the whole exam, and II-D procedures adds 17. Those two areas hold 47 of the 70. The other four (pertinent information, specialty gas, medication effects, end-of-life care) have 5 or 6 items each.

Recall, application, analysis

The outline also tags every scored item by cognitive level: 22 recall items, 79 application items and 49 analysis items. The two sections lean differently. Section I is mostly application (47 of 80) with 16 recall items. Section II has only 6 recall items and 32 analysis items, as many as its application items. Expect Section II to hand you a gas, a waveform or a set of findings and ask for the next decision, not for a definition.

Patient types: the second axis

Separately from the content areas, every form has a minimum number of items per patient-type group: at least 86 on pulmonary conditions and 34 on non-pulmonary ones. The largest pulmonary pools are neonatal pulmonary disease such as MAS, pneumonia and PPHN (15) and asthma (12). On the non-pulmonary side, neurologic, neuromuscular and congenital heart disease have 6 each. Those 34 items are where a strictly respiratory review leaves points behind. The full minimums per type are in the NPS study guide.

2025

What changed with the October 2025 outline

The outline in force since October 1, 2025 replaced the 2018 test specifications, and every sitting now follows it: 170 multiple-choice items, 4 hours, the two sections above. A lot of material written before that date is still online and some of it ranks well: third-party exam guides, flashcard decks, and the retired 2018 outline PDF itself. Those sources quote a different item count and time, and section names the 2025 outline no longer uses.

Score

NPS passing score: how the cut score works

The NPS passing score is not a published number. The scoring rule: one point per scored item, and the raw score is compared with a single cut score set by a panel of subject-matter experts. NBRC does not print the NPS cut score as a number on its NPS page. Only the 150 scored items count; the 20 pretest items add nothing either way.

Because the cut is criterion-referenced, it is a fixed standard for what a competent neonatal/pediatric specialist should get right. There is no curve: you are not competing with the people who tested the same week. You get your result at the test center, and PSI emails it within 24 hours.

Why the numbers quoted online are not a target

Forums and review sites quote a raw score out of 150 as the NPS passing score. That figure is not on NBRC’s NPS page, and nothing about the exam's design makes a candidate's recollection reliable: forms differ from person to person, and the cut comes from a panel's judgment, not a percentage rule. Treat any quoted number as hearsay.

What you can measure is your own spread. On the free 60-row practice flowsheet, sort your misses by outline area code. A run of misses in II-C costs more than the same run in I-I, because the exam has 30 items on one and 2 on the other. A practice score is a progress check, not a forecast of the cut.

Elig

Who can sit the NPS and how to register

There is one rule: you must already hold the RRT credential. The old route that let CRTs sit the NPS was removed with the 2018 test specifications. The CRT-NPS you may still see on a badge belongs to someone who passed under that old route; a therapist who holds only the CRT today reaches this exam through the RRT first (the route from RRT to NPS).

1. Confirm you hold the RRT

   This exam is a specialty added on top of the RRT, not a stand-alone credential, so the application starts from your RRT record.

2. Apply to NBRC

   Applications go through NBRC’s NPS exam page. The fee is $250 for a new application (per NBRC, as of October 2026), and there is $40 off the first application for AARC members (per NBRC, as of October 2026).

3. Book a seat with PSI

   You take it on computer at a PSI assessment center, Monday to Saturday, and book the seat online with PSI. Pick a day and time when you are sharpest: the sitting asks for 4 hours of sustained attention.

Retake

Retakes and what they cost

If you do not pass, the rule is two attempts without a wait, then at least 180 days between each later attempt, each one a new application with the reapplicant fee. Fees: $220 for a reapplication (per NBRC, as of October 2026), against $250 for a new application (per NBRC, as of October 2026) the first time.

The practical consequence: a second fail puts your next sitting at least half a year out. Before a second attempt, rebuild the plan around the outline areas where your practice misses cluster instead of rebooking fast on the same preparation.

CMP

After you pass: RRT-NPS and keeping it

Passing adds the specialty to your credential: RRT-NPS (Registered Respiratory Therapist, Neonatal/Pediatric Specialist). It is a voluntary specialty credential, not a state license; your license to practice is a separate matter handled by your state.

RRT-NPS carries a five-year credential term. Keeping it goes through the Credential Maintenance Program: quarterly online assessments plus up to 30 CRCE over five years, or passing the exam again in the last year, or earning a new NBRC credential (per NBRC, as of October 2026).

The 2027 exam change and the NPS

In January 2027 NBRC replaces the TMC and CSE with a single Respiratory Therapy (RT) exam; its announcement says nothing about the NPS, which still requires the RRT (per NBRC, as of October 2026). Until NBRC publishes something about the specialty exam itself, plan on it as this page describes it.

FAQ

Questions people ask