Respiratory Therapist (TMC – CRT/RRT)

The Certified Respiratory Therapist (CRT) and Registered Respiratory Therapist (RRT) exams are national credentialing examinations for respiratory care professionals in the United States. Both credentials are administered by the National Board for Respiratory Care and are required or strongly preferred for employment and state licensure in most U.S. jurisdictions.

These exams evaluate your ability to apply respiratory care knowledge in clinical situations. The focus is on patient assessment, equipment operation, infection control, and therapeutic decision-making.

The credentialing pathway follows a structured sequence.

• All candidates begin with the Therapist Multiple-Choice (TMC) Examination
• Performance on the TMC determines credential eligibility

Outcome based on TMC score:

This structure ensures progressive evaluation from foundational knowledge to advanced clinical judgment.

Purpose

Measures entry-level and advanced respiratory care knowledge across three content domains.

Exam format

• Multiple-choice questions with four options
• Single best answer per question
• Delivered by computer at PSI assessment centers, Monday through Saturday

Number of questions

• 160 questions: 140 scored and 20 unscored pretest items
• Pretest items are not identified, so treat every question as scored

Time limit

3 hours

Content focus

Scoring

• Two cut scores are applied: the low cut earns the CRT, and the high cut adds eligibility for the CSE
• Fee: $190 for new applicants and $150 for repeat applicants
• Three initial attempts with no waiting period, then 120 days between later attempts

Purpose

Assesses advanced clinical decision-making skills

Exam format

• Case-based clinical simulations
• Multiple decision points per scenario

Number of problems

22 problems (20 scored and 2 pretest)

Time limit

4 hours

Content focus

• Patient assessment and diagnosis
• Selection and modification of therapies
• Monitoring and outcome evaluation
• Prioritization of care

Scoring

• Based on accuracy and appropriateness of clinical decisions
• Ineffective or unsafe actions reduce score
• Fee: $200; admission requires the CRT plus a TMC pass at the high cut score

The NBRC has announced that the TMC and CSE will be replaced by a single Respiratory Therapy (RT) Examination. The new exam has 185 items (160 scored, 25 pretest) and a 4-hour limit. A low cut score awards the CRT and a high cut score awards the RRT, so the clinical simulation step is no longer separate.

Candidates who pass the TMC at the high cut score before the change keep a limited window to complete the CSE. Check the NBRC website for the date your exam version changes before you schedule. The patient data, equipment, and intervention content in this guide applies to both formats.

These credentials represent professional competency in respiratory care.

Why the exams matter:

• Required for state licensure in nearly every U.S. state that licenses respiratory therapists
• Standard hiring requirement in hospitals and clinical settings
• Demonstrates verified clinical knowledge and judgment
• Supports career advancement and professional credibility
• Establishes eligibility for advanced roles and specialty certifications

For many employers, the RRT credential is considered the professional standard for independent respiratory care practice.

The exams focus on application, not recall.

You are tested on your ability to:

• Interpret patient history and diagnostic data
• Recognize normal and abnormal findings
• Select appropriate equipment and therapies
• Adjust treatment based on patient response
• Follow infection control and safety standards

Memorization alone is not sufficient. You must understand why an action is correct and when it should be applied.

This study guide is structured to match how the CRT and RRT exams test you.

You will learn to:

• Analyze patient data efficiently
• Identify key clinical priorities
• Avoid common exam traps
• Apply concepts across multiple scenarios

Each section reinforces exam-relevant skills so you can approach the test with confidence and clarity.