HealthcareSeptember 25, 20268 min read

NBRC CSE Exam Content Outline 2026: What the RRT Simulation Tests

Every NBRC CSE domain, how much of the paper it is, what its questions ask you to do and the order to study it in, straight from the NBRC outline.

  • 3Domains
  • 22Questions
  • 240 minTime
  • Not weightedHeaviest area
  • $200Exam fee
NBRC CSE exam content outline 2026 with domain weights

Table of Contents

The outline at a glance

National Board for Respiratory Care publishes the Clinical Simulation Examination (CSE) outline that every NBRC CSE question is written against (CSE Detailed Content Outline effective January 2020; NBRC lists it as valid January 2020 - December 31, 2027 (the CSE's final day)). This page turns that document into what you actually need before you study: how big each area is, what the questions in it ask you to do, and the order to learn it in.

Heads up: the CSE ends on December 31, 2027NBRC is replacing the TMC and CSE with a single Respiratory Therapy Examination from January 1, 2027 (185 items, 160 scored, 4 hours). The CSE stays open only for candidates who reach the TMC high cut score by December 31, 2026, and its final test day is December 31, 2027. In the new exam, the CSE's role is taken by a 60-item Depth of Clinical Judgment portion.

The outline does not weight its content areas. What it does fix is the patient mix: every form is assembled from the same set of 20 scored problems.

20problems
  • Adult chronic airways disease (intubation/MV 2, noninvasive management 2, outpatient COPD 1, outpatient asthma 1, diagnosis 1)7
  • Adult medical or surgical (CF/bronchiectasis 1, infectious disease 1, ARDS 1, other 2)5
  • Adult cardiovascular (heart failure 1, other 1)2
  • Pediatric (asthma 1, other 1)2
  • Neonatal (RDS 1, resuscitation 1)2
  • Adult trauma1
  • Adult neurological or neuromuscular1
The CSE outline does not assign percentage weights to content domains; instead each section of each problem is classified to a minor content heading (e.g. I.A, II.B) and the test form is assembled by patient-problem type (20 scored problems: 7 adult chronic airways, 5 adult medical/surgical, 2 cardiovascular, 2 pediatric, 2 neonatal, 1 trauma, 1 neuro/neuromuscular). The exam has 22 problems (20 scored + 2 unidentified pretest) in 4 hours. Each problem alternates information-gathering sections ('SELECT AS MANY as you consider indicated') and decision-making sections ('CHOOSE ONLY ONE unless directed to make another selection'); once an option is chosen it cannot be unselected, and you cannot return to a prior section. Points are summed across the whole exam into one score compared to a single cut score. From January 1, 2027 the CSE is replaced by the 'Depth of Clinical Judgment' portion (60 items) of the new RT Examination (outline published Oct 2025).

What each domain actually asks

The official outline describes what each area covers. Below is what the questions in it ask you to do, which is what decides how you should study it.

I. Patient Data

It asks you to: In information-gathering sections you pick which history items, physical findings, labs and tests are actually indicated for this patient right now; the data you choose is revealed and you must then interpret it (e.g. an ABG, chest film or vent mechanics) to decide what is going on.

  • Evaluate data in the patient record (history, labs, ABGs, PFTs, imaging, sleep studies, monitoring trends)
  • Perform clinical assessment (interview, inspection, palpation, percussion, auscultation, chest radiograph review)
  • Perform procedures to gather clinical information (12-lead ECG, noninvasive monitoring, ABG sampling, SBT, auto-PEEP, plateau pressure)
  • Evaluate procedure results (cardiopulmonary calculations such as P(A-a)O2, VD/VT, P/F, OI; hemodynamics; compliance and resistance)
  • Recommend diagnostic procedures (TB testing, labs, imaging, bronchoscopy/BAL, exhaled gas analysis, thoracentesis)
  • Determination of a patient's pathophysiological state

II. Troubleshooting and Quality Control of Equipment, and Infection Control

It asks you to: Scenarios embed an equipment problem (a leaking circuit, an alarming ventilator, a malfunctioning chest drainage system, an oximeter that disagrees with the ABG) and ask you to identify the cause and choose the corrective action without harming the patient.

  • Assemble/troubleshoot oxygen interfaces, HFNC, CPAP/NPPV, humidifiers and nebulizers
  • Mechanical ventilators, breathing circuits and resuscitation equipment
  • Artificial airways, intubation and suctioning equipment
  • Pleural drainage, bronchoscopes, hemodynamic transducers and catheters
  • Infection prevention (Standard Precautions, donning/doffing, isolation, disinfection, biohazards)
  • Quality control of blood gas analyzers, gas analyzers, PFT equipment, ventilators and noninvasive monitors

III. Initiation and Modification of Interventions

It asks you to: Decision-making sections make you commit to one best next action (e.g. intubate vs. start NPPV, which vent change to make after an ABG, when to extubate), then show the consequence and move the patient forward, so wrong early decisions change the rest of the case.

  • Maintain a patent airway, including care, exchange and removal of artificial airways
  • Airway clearance and lung expansion techniques
  • Support oxygenation and ventilation (O2 therapy, CPAP, invasive/noninvasive/high-frequency ventilation, dyssynchrony, graphics, liberation)
  • Administer aerosolized medications and specialty gases (heliox, inhaled NO)
  • Recommend modifications to the care plan, including pharmacologic changes and treatment termination
  • Evidence-based practice (ARDSNet, NAEPP, GOLD)
  • High-risk situations, patient transport, and assisting physicians with procedures
  • Patient and family education (home care, smoking cessation, pulmonary rehab, disease management)

How the exam is built

ItemDetail
Questions22
Scored questions20
Unscored pretest items2
Time240 minutes
Question typesBranching patient-management simulation problems, Information-gathering sections (select as many as indicated), Decision-making sections (choose only one unless directed to make another selection)
DeliveryComputer-based at PSI assessment centers (NBRC: 'Monday through Saturday at more than 300 assessment centers across the country'); no remote-proctored option is described in the NBRC Candidate Handbook
Passing standardRRT requires passing the TMC at the high cut score (which also awards CRT) and then passing the CSE. For the CSE, 'points associated with a candidate's set of responses will be summed across the whole examination to yield one score that will be compared to the cut score'; the cut score is linked to committee decisions about whether each positively scored option is required for minimal competence. NBRC does not publish the numeric cut scores on its exam pages.
Fee$200 — CSE $200 for both new and repeat applicants; TMC $190 new / $150 repeat. From 2027 the single RT Examination costs $360 new / $300 repeat (NBRC Candidate Handbook, Sept 2026).
RetakesThree attempts without waiting; after that a minimum of 120 days between each subsequent attempt (same rule for TMC, CSE and the 2027 RT Examination).
Published pass rate63.6% (CSE new (first-time) candidates, exams given Jan 1 - Dec 31, 2025 (repeat candidates: 53.0%); 2023: 65.4%, 2024: 62.9%, 2025)

Where candidates lose marks

These are the places the outline and the real exam part ways, the parts of the outline candidates misjudge most often:

  1. Over-selecting in information-gathering sections: choosing tests that are not indicated, delay care or are harmful costs points, and you cannot unselect once the result is revealed.
  2. Jumping to treatment before assessing: CSE problems reward gathering the key data first (ABG, breath sounds, vitals, chest film) before deciding.
  3. Ignoring the neonatal and pediatric problems: 4 of the 20 scored problems are pediatric or neonatal (asthma, RDS, resuscitation), which adult-only clinical experience often under-prepares.
  4. Missing the timeline: the CSE is only open to people who pass the TMC at the high cut by Dec 31, 2026 and it ends Dec 31, 2027; after that, RRT requires the new RT Examination.
  5. Treating the CSE like multiple choice: decision-making sections branch, so an early wrong choice changes the patient's course, and you need to read each new scenario update carefully.

Turn the outline into practice

ExamCert AI has 600 RRT practice questions with explanations, built around the same outline this page walks through. Work them by domain, find the weak area, and fix it before test day.

Practise RRT on ExamCert AIHow to Become a Respiratory Therapist in 2026

FAQ

What does the NBRC Clinical Simulation Exam cover?

The CSE outline has three domains: Patient Data; Troubleshooting and Quality Control of Equipment and Infection Control; and Initiation and Modification of Interventions. Every section of every problem is tied to one of those headings, and the 20 scored problems are drawn from set patient categories such as adult chronic airways disease, ARDS, heart failure, trauma, pediatric asthma and neonatal RDS.

How many problems are on the CSE and how long do I get?

The CSE has 22 problems: 20 scored and 2 unidentified pretest problems. You get four hours to complete them all at a PSI assessment center.

How is the CSE scored?

Points from your choices across all information-gathering and decision-making sections are added into one total score, which is compared to a single cut score to decide pass or fail. The cut score reflects committee judgments about which positively scored options are required to show minimal competence.

Is the CSE going away?

Yes. The CSE is only available to candidates who pass the TMC at the high cut score by December 31, 2026, and it ends December 31, 2027. From January 1, 2027, the RRT is earned by passing the new Respiratory Therapy Examination at the high cut score; its 60-item Depth of Clinical Judgment portion replaces the simulation format.

Sources

Figures on this page come from NBRC and the other primary sources below:

Checked September 25, 2026. Fees, outlines and eligibility rules change — confirm with NBRC before you book.