- What This Credential Is and How the Exam Is Built
- Logistics Numbers on One Screen
- Domain 1 Cheat Sheet: Shared Competencies
- Domain 2 Cheat Sheet: Critical-Care Competencies
- Ventilation and Oxygenation: The Biggest Single Block
- Scoring, Pass Rates, and Retake Rules
- Eligibility and Registration Mechanics
- Renewal and Credential Maintenance at a Glance
- Scheduling Your Review Around the Blueprint
- Career Notes and Where the Credential Fits
- Frequently Asked Questions
- The exam has 170 questions: 150 scored plus 20 unidentified pretest items, with four hours on the clock.
- Domain 1 carries 80 scored items; Domain 2 carries 70, and 30 of those cover ventilation and oxygenation.
- Testing happens only at PSI testing centers; remote proctoring ended after December 31, 2024.
- 2025 pass rates were 63.4% for new candidates and 40.4% for repeat candidates.
What This Credential Is and How the Exam Is Built
The RRT-NPS is the Neonatal/Pediatric Respiratory Care Specialist credential awarded by the National Board for Respiratory Care (NBRC). You earn it by passing the Neonatal/Pediatric Specialty Examination (NPS). It is a specialty exam layered on top of the RRT credential. It is not the entry-level RRT exam, not an NNP (neonatal nurse practitioner) certification, and not the Adult Critical Care Specialty (ACCS) exam. If you want the plain-language background first, start with What Is RRT-NPS? or the shorter What Does RRT-NPS Stand For?.
This page is built to be skimmed the night before you commit to a study plan, or the week before test day. It follows the structure of the NBRC's Detailed Content Outline effective October 1, 2025, which defines two exam domains and assigns scored items to each.
Logistics Numbers on One Screen
| Item | Fact |
|---|---|
| Certifying body | National Board for Respiratory Care (NBRC) |
| Exam name | Neonatal/Pediatric Specialty Examination (NPS) |
| Testing provider | PSI, testing-center delivery |
| Total questions | 170 multiple-choice (150 scored, 20 pretest) |
| Time allowed | Four hours; breaks do not stop the clock |
| First application fee | $250 |
| Reapplication fee | $220 |
| AARC member discount | One-time $40 off first application via the prescribed AARC process, for a $210 first attempt when eligible |
| Prerequisite | Hold the NBRC RRT credential |
| Applications | Accepted year-round |
| Calculator | On-screen only; personal calculators and reference materials prohibited |
Two details trip up candidates. First, the AARC discount is not automatic: it applies only through the prescribed registration or email-link process, it is a one-time first-application benefit, and it is not applied retroactively. Second, the 20 pretest items are unidentified, so you cannot tell which questions do not count. Treat every item as scored. For the full money picture, see RRT-NPS Certification Cost 2026: Complete Pricing Breakdown.
Domain 1 Cheat Sheet: Shared Competencies
The exact heading is Competencies Shared Between Critical and General Care of Neonatal or Pediatric Patients. It holds 80 of the 150 scored items, the larger allocation. The NBRC does not print percentage weights, so think in item counts rather than rounded percentages you may see on third-party sites.
Domain 1: Shared Between Critical and General Care (80 scored items)
This domain tests whether you can reason through the bedside work that applies to a neonate in the NICU, an infant on a general ward, or a child in the emergency department.
- Assessment and pulmonary status: interpreting physical findings, vital signs, and trends in infants and children
- Causes of respiratory compromise: distinguishing pulmonary from non-pulmonary drivers of distress
- Airway management: selecting and maintaining airways appropriate to patient size and condition
- Equipment selection and troubleshooting: matching devices to the patient and fixing problems in the circuit or interface
- Procedural efficacy: deciding whether an intervention worked and what to do next
- Medication effects and interactions: expected responses, adverse effects, and combinations that complicate care
- Diagnostic results: interpreting lab, imaging, and monitoring data
- Nutrition: its role in respiratory status and recovery
- Resuscitation: recognizing arrest risk and responding appropriately
- Patient-care protocols and interdisciplinary collaboration: applying protocols and working with the care team
- Patient and family education: teaching and communication with caregivers
The cross-cutting case coverage matters here: questions draw on neonatal and pediatric pulmonary disorders, non-pulmonary disorders, and general care. A question about a child with a cardiac or neuromuscular condition can still be a respiratory question, so review how those conditions change the respiratory picture. The domain-by-domain breakdown lives in RRT-NPS Exam Domains 2026: Complete Guide to All 2 Content Areas.
Domain 2 Cheat Sheet: Critical-Care Competencies
The exact heading is Competencies Specific to Critical Care of Neonatal or Pediatric Patients. It holds 70 scored items.
Domain 2: Specific to Critical Care (70 scored items)
Expect higher-acuity scenarios where the patient is on or near advanced support.
- Pertinent critical-care information: the clinical context needed to make sound decisions in an intensive care setting
- Specialty gases: indications, delivery, monitoring, and hazards
- Ventilation and oxygenation: 30 scored items, the largest single block in the domain
- Procedural efficacy: evaluating critical-care interventions and adjusting
- Medication administration: delivering and evaluating therapies in critically ill patients
- End-of-life care: supporting patients and families when the goals of care change
Ventilation and Oxygenation: The Biggest Single Block
Thirty scored items sit in the ventilation and oxygenation subsection of Domain 2. That is roughly one in five scored questions on the whole exam, which makes it the highest-yield area to practice with cases rather than flashcards. These questions typically hand you a clinical picture plus data and ask for the next decision, so recall alone is rarely enough.
Case Patterns to Rehearse
- A neonate or child on mechanical ventilation whose blood gas shows a problem with ventilation, oxygenation, or both, and you must choose the adjustment that addresses the actual problem
- A patient who deteriorates suddenly on the ventilator, where you must work through the equipment, the airway, and the patient in a sensible order
- A patient whose oxygenation targets matter because of age or underlying condition
- A weaning or escalation decision based on trends in the data
Habits That Pay Off
- Separate ventilation problems from oxygenation problems before reaching for any setting change
- Ask what the data says about the trend, not just the single value
- Use the on-screen calculator for calculation items, and practice with a similarly basic tool so the format feels familiar
- Check whether the stem is asking for the first action, the best action, or the most likely cause
Key Takeaway
Because ventilation and oxygenation is the largest single block, spend a disproportionate share of case practice here, then use it as the bridge to Domain 1 topics like airway management and equipment troubleshooting, which show up inside the same scenarios.
Scoring, Pass Rates, and Retake Rules
The NBRC scores the NPS by comparing your raw number of correct answers against an expert-panel-derived cut score. The public issuer materials do not state a current numeric NPS cut score, so no fixed percentage should be treated as the passing line. If you see a specific "you need X%" claim, be skeptical. Our RRT-NPS Passing Score 2026 article explains what is and is not known.
| 2025 Data Point (NBRC) | Value |
|---|---|
| New-candidate pass rate | 63.4% |
| Repeat-candidate pass rate | 40.4% |
| NPS examinations administered | 1,712 |
| Credentials awarded | 961 |
Read these numbers carefully. The 2025 rates span the October blueprint transition, so they are not exclusively outcomes for the current exam version, and full-year 2026 results are not yet available. The cumulative 21,002 credentials awarded through December 31, 2025 are historical awards, not a count of currently active practitioners. The gap between new and repeat candidates is the practical lesson: a repeat attempt without a changed preparation strategy has historically performed worse. More context is in RRT-NPS Pass Rate 2026: What the Data Shows and How Hard Is the RRT-NPS Exam?.
Attempt Rules
- Two initial attempts are permitted without the subsequent-attempt waiting restriction
- Later attempts require 180 days between attempts
- Reapplication costs $220 each time
Eligibility and Registration Mechanics
The gateway requirement is holding the NBRC RRT credential. The NPS admission policy does not add a specified NICU employment duration, a separate training-hour minimum, or a reference requirement. That means a newly credentialed RRT is not formally blocked by the NBRC from applying, though a realistic study plan should still account for how much neonatal and pediatric exposure you have. The full eligibility discussion is in RRT-NPS Requirements 2026: Eligibility, Prerequisites & How to Qualify.
- Confirm your RRT credential is in good standing with the NBRC
- If you qualify for the AARC discount, start through the prescribed AARC registration or email-link process before paying, since it is not applied after the fact
- Submit your application and fee (applications are accepted year-round)
- Schedule at a PSI testing center
- Take the official free practice examination and consider the paid self-assessment as preparation tools; neither is a required qualifying exam
Test-Day Policies Worth Memorizing
- Closed-book computer testing
- On-screen calculator only
- Breaks do not pause the four-hour clock, so decide in advance whether you will take one
- With 170 questions in 240 minutes, you have a bit over 85 seconds per item on average, which favors steady pacing over lingering on any single stem
Renewal and Credential Maintenance at a Glance
The credential is valid for five years from the end of the issuance month, per the NBRC Credential Maintenance Program (CMP) brochure revised October 7, 2026. Renewal offers alternatives, and you need only one path:
- Assessment and CE compliance: your assessment performance sets CE documentation at 0, 15, or 30 credits
- Retake the highest applicable credential exam in the last year of the term
- Earn a new NBRC credential
For an RT plus one specialty, the current chart splits the 30-credit requirement into 15 general respiratory and 15 specialty credits, or the 15-credit requirement into 7.5 general and 7.5 specialty. Other credential combinations are allocated differently, so check the NBRC chart for your situation. CMP annual fees are $25 for payment years before 2027 and $30 from payment year 2027; a five-year term entirely at the higher rate totals $150. Exam-based renewal instead requires the relevant examination fee, and state-license renewal is a separate obligation entirely.
Scheduling Your Review Around the Blueprint
Generic study advice is plentiful; the useful question is how to order your weeks given this exam's structure. One sensible sequencing, built on the item allocations above:
Domain 1 Foundations
- Assessment, causes of compromise, and diagnostic interpretation across neonates and children
- Airway management and equipment troubleshooting, since these feed every later case
Ventilation and Oxygenation Cases
- Work case after case in the 30-item block while foundations are fresh
- Pair each case with the Domain 1 concept that explains the cause
Remaining Domain 2 Topics
- Specialty gases, critical-care medications, and end-of-life care
- Procedural efficacy: practice deciding whether an intervention worked
Full-Length Rehearsal
- Sit a timed, closed-book run using the official free practice exam and our RRT-NPS practice tests
- Review misses by domain and revisit the weakest subsection
Adjust the length to your own exposure. A therapist who works daily in a NICU may compress Domain 1 and spend longer on pediatric critical-care content; someone from a general pediatric floor may do the opposite. Our RRT-NPS Study Guide 2026 expands this into a fuller plan, and you can test your recall anytime on the main practice test site. One caution: a practice product's question count or timer is not the real exam's 170 questions and four hours, so do at least one rehearsal at the real length to build stamina.
Career Notes and Where the Credential Fits
Typical settings for neonatal and pediatric respiratory specialists include NICUs, pediatric ICUs, children's hospitals, and transport teams, along with general pediatric units. See RRT-NPS Jobs for the landscape.
On pay, be careful. Salary searches are common, but no credential-specific salary uplift has been established. General respiratory-therapist pay, employer-specific differentials, and a demonstrated certification premium are three different things, and many online figures blur them. Check your own employer's policy on specialty pay or advancement, then read RRT-NPS Salary Guide 2026 and Is the RRT-NPS Certification Worth It? before deciding.
NPS Versus ACCS in One Look
| Question | NPS (Neonatal/Pediatric) | ACCS (Adult Critical Care) |
|---|---|---|
| Patient population | Neonates and children | Adults |
| Credential | RRT-NPS | RRT-ACCS |
| Prerequisite | NBRC RRT credential | NBRC RRT credential |
| Best fit | NICU, PICU, pediatric care | Adult ICU practice |
Choose based on the patients you serve or want to serve, not on a generic salary promise.
Frequently Asked Questions
The exam has 170 multiple-choice questions. Of those, 150 are scored and 20 are unidentified pretest items that do not count. Since you cannot tell which is which, treat every question as if it counts. You have four hours to finish.
Domain 1 is Competencies Shared Between Critical and General Care of Neonatal or Pediatric Patients, with 80 scored items. Domain 2 is Competencies Specific to Critical Care of Neonatal or Pediatric Patients, with 70 scored items, including 30 on ventilation and oxygenation. The NBRC does not publish percentage weights.
No. The NBRC discontinued live remote proctoring after December 31, 2024, and since January 1, 2025 the exam must be taken at a PSI testing center. Ignore any older source that says otherwise.
You get two initial attempts without the extra waiting restriction. After that, later attempts require 180 days between tries. Each reapplication costs $220. Because 2025 repeat-candidate results were lower than new-candidate results, change your preparation approach before retesting rather than repeating the same plan.
It is valid for five years from the end of the issuance month. Under the Credential Maintenance Program, annual fees are $25 for payment years before 2027 and $30 from payment year 2027. Alternatively, you can renew by retaking the highest applicable credential exam in the final year, which costs the relevant exam fee. State licensure renewal is separate.