NPS · neonatal/pediatric specialty
RRT-NPS: what the NBRC Neonatal/Pediatric Specialty credential is and how to earn it
RRT-NPS is the credential a Registered Respiratory Therapist earns by passing NBRC's Neonatal/Pediatric Specialty exam (NPS): 170 multiple-choice items in 4 hours, split into two content sections. You can sit it only once you hold the RRT. Eight sample rows from both sections are on the practice sheet on this page.
- Items
- 170MCQ
- Pretest
- 20unscored
- Time
- 4hours
- Term
- 5years
Bedside check · 8 sample rows
0 of 8 charted · 0 correct
Right/answered: I 0/0 · II 0/0
In the acute management of a 26-week premature infant with surfactant deficiency, why is regular assessment using the Silverman-Andersen score important?
Pick A to D. The rationale opens in this box.
A 9-year-old immunocompromised patient presents with fever and respiratory distress. Laboratory results reveal significantly elevated serum beta-D-glucan levels. Which pathogen is most commonly associated with this laboratory finding in immunocompromised patients?
Pick A to D. The rationale opens in this box.
An immunocompromised pediatric patient exhibits subtle respiratory symptoms with a normal chest X-ray. Which imaging modality should be utilized to improve detection of early pulmonary infections?
Pick A to D. The rationale opens in this box.
Which biomarker is most useful in guiding initiation of biologic therapy for eosinophilic inflammation in pediatric asthma?
Pick A to D. The rationale opens in this box.
Which ventilator strategy is most associated with the lowest risk of developing barotrauma in an infant with chronic lung disease while ensuring adequate ventilation?
Pick A to D. The rationale opens in this box.
A 7-year-old patient on mechanical ventilation for inhalation injury has persistent hypoxemia despite lung-protective strategies. Which adjunctive therapy can improve oxygenation without increasing ventilator pressures?
Pick A to D. The rationale opens in this box.
A 26-week premature infant on CPAP exhibits a progressive decline in dynamic lung compliance along with rising oxygen requirements. In the setting of suspected surfactant deficiency, what is the most likely explanation and subsequent intervention?
Pick A to D. The rationale opens in this box.
In a pediatric patient with chemical inhalation injury, which early intervention is critical to prevent progression to airway obstruction secondary to edema?
Pick A to D. The rationale opens in this box.
Review grid: jump to any row
Keys: A–D or 1–4 to answer, arrow keys to move
Defn
What RRT-NPS stands for
Spelled out, the letters are RRT-NPS (Registered Respiratory Therapist, Neonatal/Pediatric Specialist). The two halves are separate credentials from the National Board for Respiratory Care (NBRC): the RRT is the general respiratory therapy credential, and NPS is a specialty stacked on top of it. Passing the NPS adds the suffix; it never replaces the RRT, and without the RRT the specialty has nothing to sit on.
You will still see a second spelling on badges and in hospital directories. CRT-NPS is a legacy designation still held by earlier CRT passers. Nobody earns it today, because the exam is closed to CRTs, so a new pass always reads RRT-NPS.
One search-result oddity: "NPS credential" also matches National Performance Specialists, an unrelated certification company with the same initials. If a result is not about infants and children, it is not this exam.
Elig
Who can sit the NPS
The rule fits in one line: you must already hold the RRT credential. NBRC's admission rule for the NPS is the credential itself, not a count of months in a NICU or on a pediatric floor.
Still on the way to the RRT? The whole sequence, from school to the specialty, is laid out in how to become a NICU respiratory therapist.
Outline
The exam, one section at a time
The NPS follows the Detailed Content Outline effective October 1, 2025. You get 170 multiple-choice items: 150 scored items and 20 unscored pretest items mixed in where you cannot spot them. The scored part divides into two content sections, close to an even split.
Section I: shared care, 80 items
Competencies Shared Between Critical and General Care of Neonatal or Pediatric Patients. It has 13 content areas, and the largest, I-A Assess Information, holds only 12 items. That spread is the difficulty: nothing here is deep, but nutrition, family education and team communication each get a few rows, and bedside work rarely drills them. The trap is skipping the small areas because they look cheap; together the 6 areas under five items carry 19 points. Area by area: the Section I shared care guide.
Section II: critical care, 70 items
Section II has 6 areas, and one of them carries 43% of the section. II-C Manage Ventilation and Oxygenation is 30 items, about one scored question in five on the whole exam. The trap here is the opposite of Section I: people who work a NICU know this material, then lose points on the wording, because 32 of the 70 items are analysis items that ask you to judge a change rather than recall a fact. Walk-through: the Section II critical care guide.
| Section | Scored items | Recall | Application | Analysis |
|---|---|---|---|---|
| I · Shared care | 80 | 16 | 47 | 17 |
| II · Critical care | 70 | 6 | 32 | 32 |
Across both sections the outline also sets a minimum number of items per patient-type group on every form: at least 86 items on pulmonary conditions (prematurity, asthma, bronchiolitis, pediatric ARDS and others) and at least 34 on non-pulmonary ones such as congenital heart disease, neuromuscular disease and shock. Each sitting is a linear-on-the-fly form: every candidate gets a different form assembled from item sampling groups to the same specification. Scoring, delivery and retakes in detail are on the NPS exam page.
Rules
Test day on one sheet
| Item | What NBRC publishes |
|---|---|
| Format | 170 multiple-choice items |
| Time | 4 hours |
| Delivery | Computer-based testing at PSI assessment centers, Monday through Saturday except holidays, booked online through PSI |
| Scoring | One point per scored item, and the raw score is compared with a single cut score set by a panel of subject-matter experts |
| Cut score | NBRC does not print the NPS cut score as a number on its NPS page |
| Result | You get your result at the test center, and PSI emails it within 24 hours |
| Retakes | Two attempts without a wait, then at least 180 days between each later attempt, each one a new application with the reapplicant fee |
Sources: NBRC NPS exam page, NBRC Candidate Handbook (Sept 2026). Checked October 2026.
You cannot tell which 20 of the 170 items are pretest, so every row gets your full attention.
Pace for the whole form: 4 hours over 170 items is about 85 seconds each. Analysis rows take longer than that and recall rows far less, so bank time on the quick ones instead of rushing the last hour.
Rows
The eight sample rows on this page
The sheet at the top holds 8 rows, half from each section, each tagged with its outline area code. They are NPS-style practice questions written to the outline, not items from the exam itself. Read the area code before the stem: it tells you what kind of answer is being asked for, which matters because the same patient type turns up in both sections.
| Section | Rows | Area codes | Patient types in the stems |
|---|---|---|---|
| I · Shared care | 4 | I-A, I-G | Asthma, Immunocompromised, Prematurity acute phase |
| II · Critical care | 4 | II-B, II-C, II-D, II-E | Chronic lung disease of prematurity, Inhalation injuries, Prematurity acute phase |
Acute-phase prematurity appears twice: once under I-A, where the row is about assessing work of breathing, and once under II-E, where it is about a medication. Same kind of patient, a different job. Sixty rows in the outline's proportions are on the free NPS practice test.
Eight rows here, the full bank in the app
The Small Airways app (iPhone and iPad) carries the full 1,055-question NPS bank with a rationale on every item, split by the two outline sections.
Plan
How to prepare, in order
Read the outline against your unit
Open the NPS study guide and mark every area code you have not touched at work in the last year. Pediatric-floor therapists often mark neonatal delivery-room care; NICU-only therapists mark asthma and pediatric ARDS.
Start with Section II, area II-C
30 items on one code repays the first week. Work through Section II and its depth rows before anything else.
Sweep the small Section I areas
Nutrition, procedures, resuscitation and family education are two to three items each. Give each pair one focused evening with the Section I guide.
Run full-length practice
Sit the 60-row practice flowsheet in one go, then sort your misses by area code. Reread only the codes you missed twice.
Keep
Keeping the credential
A pass gives you a five-year credential term. To renew it you go 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). Your own renewal dates sit in your NBRC account; this site does not track them.
Hand-off notes
- RRT-NPS = the RRT plus NBRC's neonatal/pediatric specialty; you must already hold the RRT credential.
- 80 scored items in Section I (breadth, 13 areas), 70 in Section II (II-C alone is 30).
- Pace for all 170 items; the 20 pretest rows are hidden.
- Renewal runs on a 5-year term through the Credential Maintenance Program.
FAQ
Questions people ask
What does RRT-NPS stand for?
RRT-NPS (Registered Respiratory Therapist, Neonatal/Pediatric Specialist). It goes after your name once you hold the RRT and have passed NBRC's Neonatal/Pediatric Specialty exam.
Can a CRT take the NPS exam?
No. You must already hold the RRT credential. The CRT route closed with the 2018 test specifications, so the older CRT-NPS designation is no longer awarded.
Is the NPS a license?
No. It is a voluntary specialty credential, not a state license. Your license comes from your state; the NPS shows specialty knowledge in neonatal and pediatric care.
How many questions are on the NPS exam?
170 multiple-choice items: 150 scored items and 20 unscored pretest items, in 4 hours. Section I holds 80 of the scored items and Section II holds 70.
How do you get the RRT-NPS?
Earn the RRT first, apply to NBRC for the NPS, book a seat at a PSI test center, and pass. The RRT is the admission requirement; the old CRT route no longer exists.
Is the NPS exam hard?
It is mostly a reasoning exam: only 22 recall items out of 150, against 79 application items and 49 analysis items. Section II carries most of the analysis load, so that is where well-prepared candidates still lose points.
What does NBRC stand for?
The National Board for Respiratory Care (NBRC). It writes and runs the NPS along with the other respiratory therapy credentials.
Does the 2027 NBRC exam change affect 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).
Chart the next row
Sixty free rows on this site, both sections in proportion; the full 1,055-question bank in the app.