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Which transcutaneous monitor is most useful for trending ventilation in a neonate on mechanical ventilation?

A
B
C
D
to track
2026 Statistics

Key Facts: NPS Exam

170

Total Items

NBRC NPS DCO October 2025

150

Scored Items

NBRC NPS DCO October 2025

4 hours

Time Limit

NBRC

$250

New Applicant Fee

NBRC 2026

RRT

Required Prerequisite

NBRC

PSI

Testing Centers

NBRC

The NBRC NPS examination contains 170 multiple-choice items (150 scored + 20 pretest) administered over 4 hours through PSI testing centers. Scored items are split between Competencies Shared Between Critical and General Care (80 items, 53%) and Competencies Specific to Critical Care of Neonatal or Pediatric Patients (70 items, 47%). Candidates must hold the RRT credential before applying.

Sample NPS Practice Questions

Try these sample questions to test your NPS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A term newborn at 1 minute of life has a heart rate of 110, weak cry with some flexion, grimaces with stimulation, and acrocyanosis. What is the Apgar score?
A.5
B.6
C.7
D.8
Explanation: HR >100 = 2, weak cry with some flexion = 1 (respiratory effort) + 1 (tone), grimace = 1, acrocyanosis = 1. Total = 2+1+1+1+1 = 6.
2A 4-year-old child requires endotracheal intubation. Using the standard formula for an uncuffed tube, what size ETT should be selected?
A.4.0 mm
B.4.5 mm
C.5.0 mm
D.5.5 mm
Explanation: Uncuffed ETT size = (age/4) + 4 = (4/4) + 4 = 5.0 mm internal diameter.
3A 5 kg infant is being intubated with a 4.0 mm uncuffed ETT. What is the correct insertion depth at the lip?
A.10 cm
B.12 cm
C.14 cm
D.16 cm
Explanation: ETT insertion depth at the lip = 3 x ETT internal diameter = 3 x 4.0 = 12 cm.
4A newborn has a preductal SpO2 of 95% and a postductal SpO2 of 82%. What does this finding most likely indicate?
A.Normal transitional circulation
B.Right-to-left shunting through the ductus arteriosus
C.Sensor malfunction on the postductal site
D.Severe anemia
Explanation: A pre-postductal SpO2 difference greater than 10% indicates right-to-left shunting through the patent ductus arteriosus, suggesting persistent pulmonary hypertension of the newborn (PPHN) or a ductal-dependent cardiac lesion.
5Which oxygen delivery device can reliably provide an FiO2 of 0.60-0.90 to a cooperative pediatric patient?
A.Nasal cannula at 4 L/min
B.Simple mask at 6 L/min
C.Non-rebreathing mask at 12 L/min
D.Venturi mask at 0.40 setting
Explanation: A non-rebreathing mask with a one-way valve and reservoir bag at 10-15 L/min delivers 60-90% FiO2 in cooperative patients.
6What is the normal respiratory rate range for a healthy term newborn?
A.15-25 breaths/min
B.20-30 breaths/min
C.30-60 breaths/min
D.60-80 breaths/min
Explanation: Normal newborn respiratory rate is 30-60 breaths/min. Rates outside this range may indicate respiratory distress.
7When using a small-volume nebulizer for a 2-year-old child, what is the recommended interface?
A.Mouthpiece with nose clips
B.Aerosol mask covering nose and mouth
C.Blow-by with the nebulizer held 4 inches from the face
D.T-piece on a ventilator only
Explanation: Children younger than 3 years cannot reliably use a mouthpiece, so an aerosol mask sealed to the face is the recommended interface to maximize aerosol delivery.
8A 6-year-old asthmatic is prescribed albuterol via MDI with a valved holding chamber. What is the most important instruction for proper technique?
A.Take 5 quick deep breaths from the spacer after each actuation
B.Actuate one puff and take 5-6 tidal breaths through the spacer
C.Hold breath for 30 seconds after each puff
D.Actuate 3 puffs simultaneously into the chamber
Explanation: For children using a VHC, the correct technique is one actuation followed by 5-6 slow tidal breaths through the chamber. This allows the medication to remain suspended and be inhaled through normal breathing.
9Which transcutaneous monitor is most useful for trending ventilation in a neonate on mechanical ventilation?
A.TcPO2
B.TcCO2
C.End-tidal CO2 sidestream
D.Pulse oximetry
Explanation: TcCO2 (transcutaneous CO2) provides continuous, noninvasive trending of ventilation status in neonates, especially when arterial access is limited and ETCO2 is unreliable due to small tidal volumes and ETT leaks.
10A capillary blood gas on a stable preterm infant shows pH 7.34, PCO2 42, PO2 38, HCO3 22. How should the PO2 be interpreted?
A.Severe hypoxemia requiring immediate FiO2 increase
B.Expected; capillary PO2 does not reliably reflect arterial PO2
C.Indicative of intrapulmonary shunt
D.Sample contaminated with venous blood
Explanation: Capillary blood gas PO2 values are unreliable for assessing oxygenation because they are influenced by perfusion and warming of the heel. Use SpO2 or arterial samples to assess oxygenation; capillary gases are useful only for pH and PCO2 trends.

About the NPS Exam

The RRT-NPS is the NBRC specialty credential for respiratory therapists who care for neonatal and pediatric patients. The exam validates competency in shared neonatal and pediatric respiratory care plus critical-care management of newborns, infants, and children.

Questions

170 scored questions

Time Limit

4 hours

Passing Score

Determined by NBRC standard-setting (low-cut method)

Exam Fee

$250 ($220 reapplicant) (NBRC)

NPS Exam Content Outline

80 items (53%)

Competencies Shared Between Critical and General Care of Neonatal or Pediatric Patients

Assess medical history, physical, labs, and imaging; recognize pulmonary, cardiovascular, neurologic, and metabolic mechanisms; evaluate gas exchange and pulmonary function; manage airways, equipment, and medications; anticipate care based on diagnostics and nutrition; assist with resuscitation; implement protocols; collaborate with the interdisciplinary team; and verify patient and family education.

70 items (47%)

Competencies Specific to Critical Care of Neonatal or Pediatric Patients

Evaluate critical-care information; manage specialty gases such as inhaled nitric oxide and helium-oxygen; manage ventilation and oxygenation including conventional, HFOV, NAVA, NIV, and weaning; facilitate procedures such as ECMO, surfactant administration, and bronchoscopy; manage medication effects including sedatives, paralytics, and airway instillations; and support end-of-life care, brain death determination, and organ donor management.

How to Pass the NPS Exam

What You Need to Know

  • Passing score: Determined by NBRC standard-setting (low-cut method)
  • Exam length: 170 questions
  • Time limit: 4 hours
  • Exam fee: $250 ($220 reapplicant)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

NPS Study Tips from Top Performers

1Drill the current NRP algorithm including heart rate thresholds, PPV initiation, chest compression triggers, and epinephrine timing
2Memorize neonatal HFOV starting parameters (MAP 1-2 cmH2O above conventional, frequency 10-15 Hz for premature infants) and how to adjust amplitude versus frequency
3Know surfactant agent doses (beractant 100 mg/kg, poractant alfa 200 mg/kg) and the LISA/INSURE administration approaches
4Use the PALICC-2 oxygenation index thresholds (mild OI 4-<8, moderate 8-<16, severe >=16) to grade pediatric ARDS
5Learn ECMO referral triggers including OI greater than 40 sustained for 4-6 hours, and the disease-specific survival rates
6Practice pediatric ETT sizing (uncuffed = age/4 + 4, cuffed = age/4 + 3.5) and depth-of-insertion rules

Frequently Asked Questions

What is the NBRC RRT-NPS exam format?

The RRT-NPS examination consists of 170 multiple-choice items (150 scored and 20 pretest) administered over a 4-hour time limit. The exam is computer-based and delivered through PSI testing centers using a linear-on-the-fly system that assembles forms from minipool item sampling groups.

What are the RRT-NPS exam content domains?

The NPS exam has two major sections per the October 2025 Detailed Content Outline. Section I, Competencies Shared Between Critical and General Care of Neonatal or Pediatric Patients, contains 80 scored items (53%). Section II, Competencies Specific to Critical Care of Neonatal or Pediatric Patients, contains 70 scored items (47%), with the largest single subdomain being Manage Ventilation and Oxygenation (30 items).

How much does the RRT-NPS exam cost?

The NPS examination fee is $250 for new applicants and $220 for reapplicants. AARC members may qualify for a one-time $40 discount on a first application through the AARC member pathway.

What are the eligibility requirements for the RRT-NPS exam?

Candidates must hold the NBRC Registered Respiratory Therapist (RRT) credential before they may apply for the NPS specialty examination. Candidates apply through NBRC and then schedule a seat through PSI.

What is the RRT-NPS retake policy?

NBRC specialty exam policy allows two initial attempts without a waiting period. Any subsequent attempts require a 180-day wait between exams. Reapplicants pay the $220 reapplicant fee for each attempt after the first two.

Which patient populations does the RRT-NPS exam cover?

The exam draws items from neonatal pulmonary disorders (such as RDS, meconium aspiration, PPHN, BPD), pediatric airways and parenchymal disease (asthma, bronchiolitis, cystic fibrosis, pediatric ARDS), and non-pulmonary disorders (congenital heart disease, neuromuscular disease, sleep-disordered breathing, shock, and trauma) as defined in the NBRC Additional Specifications table.