NPS Study Guide

DCO

The 2025 outline, section by section

The NPS follows the Detailed Content Outline effective October 1, 2025, and that outline has two content sections. Section I, competencies shared between critical and general care, holds 80 of the 150 scored items. Section II, competencies specific to critical care, holds 70 of the 150 scored items. On top of those sit 20 unscored pretest items that you cannot tell apart from the rest, which is why the exam is 170 multiple-choice items long (NPS Detailed Content Outline (Oct 2025)).

The near-even split hides a lopsided inside. Section I spreads its 80 items over 13 areas, and the largest of them, I-A Assess Information, is only 12. Section II packs its 70 into 6 areas, and one of them, II-C Manage Ventilation and Oxygenation, takes 30. That single area outweighs any two areas of Section I put together, and II-C plus II-D (procedures, 17) make up 47 of Section II's 70.

How the items think: recall, application, analysis

The outline also sorts every item by the thinking it asks for. Across the form that is 22 recall items, 79 application items and 49 analysis items. The two sections lean differently: Section I is mostly application (47 of 80), while Section II splits evenly between application and analysis (32 and 32 of 70) and has only 6 recall items.

Analysis items hand you a patient, a trend in the numbers and four plausible next moves. Flashcards will not get you through them; working whole cases will. Plan your Section II time around that.

Guides

NPS section guides

Each section has its own guide on this site, with every content area, the traps the practice rows keep exposing, and a 12-row drill at the top. Start with the Section II critical care guide if your exam is under a month away; it carries the heavier analysis load. The Section I shared care guide is the breadth pass.

• Live guide

  I. Competencies Shared Between Critical and General Care

  80 items · 53.3%

• Live guide

  II. Competencies Specific to Critical Care

  70 items · 46.7%

• Planned

  II-C Manage Ventilation and Oxygenation (deep dive)

  30 items · 20.0%

• Planned

  Patient type: prematurity (RDS/surfactant, apnea) + chronic lung disease

  min. 11 + 11 items

• Planned

  Patient type: asthma

  min. 12 items

The dashed cards are the next guides in line: a II-C ventilation deep dive, prematurity and surfactant, and pediatric asthma. The two section guides already cover that ground at area level.

Pts

The patient-type axis

The outline has a second axis that most study guides skip. Besides its content area (I-A through II-F), every item is tied to a patient type, and the outline sets a minimum number of items for each type in the item pool every form is drawn from. Per form it fixes only the totals: at least 86 pulmonary and 34 non-pulmonary items. Each sitting is a linear-on-the-fly form: every candidate gets a different form assembled from item sampling groups to the same specification, and those totals are what make your form and the next candidate's cover the same mix of patients.

Neonatal pulmonary disease (meconium aspiration, pneumonia, PPHN) leads with at least 15 items. Asthma follows at 12, then three types at 11 each: chronic lung disease of prematurity, infectious disease such as pneumonia and croup, and the acute phase of prematurity (RDS, surfactant, apnea). Bronchiolitis and pediatric ARDS sit at 8. The non-pulmonary list is shorter: neurologic, neuromuscular and congenital heart disease each have a floor of 6.

How to use the second axis

Study by area first, then do one pass by patient type. Take the five types above and ask the same question of each: what would you assess, what would you change at the bedside, and what would make you escalate. That pass catches the gaps that area-by-area study leaves, especially for a type your unit rarely admits. A therapist from a level III NICU often meets asthma and croup only on paper, and a PICU therapist has the same problem with surfactant and apnea of prematurity.

Plan

A 4–6 week NPS study plan for working RRTs

This plan assumes you work three 12-hour shifts a week and study on the other days. Six weeks is comfortable; for four, merge weeks 2 and 3 and weeks 5 and 6. Weeks 2 to 4 each take a named slice of the outline, and together they cover all 150 scored items.

1. Week 1 · Baseline

   Read the outline once, start to finish. Then run the 60-row NPS practice test cold, both sections, no notes. Sort every miss by its area code. That list is your syllabus; anything you got right on reasoning, not luck, drops down the queue.

2. Week 2 · II-C ventilation and oxygenation (30 items)

   The heaviest block first, while your energy is fresh. Cover neonatal and pediatric cases side by side: initial settings, invasive and noninvasive modes, high-frequency ventilation, prone positioning and ECLS, and how to read a blood gas trend after a setting change. Work every case to the next move, not just the diagnosis.

3. Week 3 · The rest of Section II (40 items)

   II-D procedures (17) first, then specialty gases (II-B, 5), medication effects (II-E, 6), pertinent information (II-A, 6) and end-of-life care (II-F, 6). The small areas are quick, but end-of-life items are application and analysis, not definitions; read them as a team-communication problem.

4. Week 4 · Section I breadth (80 items)

   Assessment (I-A, 12), then the four 9-item areas: airway (I-D), equipment and troubleshooting (I-E), medications (I-G) and diagnostic results (I-H). Leave the 2–5 item areas for the last two evenings. Section I rewards wide, shallow coverage.

5. Week 5 · Patient-type pass

   Go through the patient types instead of the areas: the five largest pulmonary types, then the non-pulmonary ones you rarely see at work. Re-run the practice rows you missed in week 1 and check whether the same area codes still come up.

6. Week 6 · Timed full run, then book

   Sit a full-length practice exam, such as an NBRC SAE, under exam timing: 4 hours for 170 items is about 85 seconds each, with no clue which 20 are pretest. Then book your seat; delivery is computer-based testing at PSI assessment centers, Monday through Saturday except holidays, booked online through PSI.

Review

NPS review options compared

There is no single best NPS study guide, and NBRC does not endorse any review program: no review product, this site included, carries NBRC's backing. The useful question is which format fits how you learn and whether the material matches the current outline.

Three checks before you pay for anything

First, the outline date: material built before October 1, 2025 follows an older outline with different section names. Second, the section names: the current ones are shared care (Section I) and critical care (Section II). Third, the counts: 170 multiple-choice items, 150 scored items. A guide that fails any of the three will have you studying a blueprint that no longer exists.

Whatever you buy, keep the free outline itself open beside it: it is the NPS Detailed Content Outline on nbrc.org, and it is the one document every option above is trying to cover.

Notes

Before you start

FAQ

Questions people ask