The 2027 NBRC® Respiratory Therapy Examination® marks a major shift in how clinical judgment is tested.
Instead of two separate exams—the TMC and the CSE—the new structure combines both breadth of knowledge and depth of clinical judgment into a single, integrated exam.
This change means every candidate, whether pursuing the CRT or RRT credential, must demonstrate the ability to apply knowledge, interpret data, and make sound clinical decisions in real-world scenarios.
Why the Change Matters
The NBRC’s 2024 job analysis revealed that respiratory therapists use clinical reasoning and technical knowledge together in daily practice.
As a result, starting in January 2027, the NBRC will use one combined exam to reflect modern respiratory care, ensuring that successful candidates can apply what they know rather than simply recall facts.
How Clinical Judgment Is Now Built Into the Exam
The new Respiratory Therapy Examination includes:
- 100 Breadth of Knowledge questions (traditional multiple-choice)
- 60 Depth of Clinical Judgment questions
All 160 questions contribute to a single score. This eliminates separate pass/fail sections and instead measures the therapist’s ability to interpret data and make decisions based on evolving patient conditions.
Understanding the Depth of Clinical Judgment Section
The 60-question clinical judgment section focuses on realistic patient scenarios that test a candidate’s ability to assess, analyze, and act appropriately.
What’s Being Tested
Each item evaluates how you:
- Gather and interpret patient data
- Identify the most appropriate next step
- Modify or discontinue therapy when needed
- Recognize and respond to complications or changes in condition
These questions are still multiple-choice but test at the application and analysis levels of cognition, not recall.
Common Clinical Judgment Types in the 2027 NBRC Exam
The NBRC has defined two main categories of clinical judgment items.
Information Gathering (IG)
These questions ask what additional information you would collect or interpret next.
Example: “Which of the following additional assessments should the therapist perform first?”
Decision Making (DM)
These questions ask what to add, modify, continue, or discontinue in patient care.
Example: “Based on these findings, which action should the therapist take next?”
Each exam form includes approximately 20 IG and 40 DM questions, mirroring the decision-heavy nature of respiratory care practice.
Example Question: Depth of Clinical Judgment
A 68-year-old male with COPD is receiving oxygen by nasal cannula at 3 L/min. His SpO₂ has dropped to 86%, and his PaCO₂ has increased from 50 to 62 mm Hg.
Which action should the respiratory therapist take next?
A. Increase the oxygen flow to 5 L/min
B. Decrease the oxygen flow to 2 L/min
C. Switch to a Venturi mask at 28%
D. Initiate noninvasive ventilation
Correct Answer: D
Rationale: The elevated PaCO₂ indicates worsening ventilatory failure. Increasing oxygen without addressing ventilation could worsen hypercapnia. The appropriate response is to initiate noninvasive ventilation for ventilatory support.
Multipurpose Items and Overlapping Reasoning
Many questions now serve multiple purposes.
A single item may require you to interpret test results, apply ethical reasoning, and decide on an intervention—all within one question.
This reflects how therapists function in real settings, integrating data interpretation, communication, and ethics to guide care decisions.
Ethics Within Clinical Judgment
Ethical decision-making is now integrated throughout the new exam. Cultural and trauma-informed care factors can also influence clinical judgment, and the 2027 NBRC exam now includes scenarios that require recognizing these patient-centered cues.
Expect questions involving:
- Patient consent and autonomy
- Cultural awareness and communication
- Safe delegation and collaboration
- Response to errors or adverse events
These concepts will not appear as stand-alone ethics questions but will be woven into patient-based scenarios.
How to Prepare for Clinical Judgment Questions
- Focus on clinical reasoning, not just memorization. Understand the “why” behind each action.
- Use NBRC-style case questions that require interpretation of patient data.
- Review critical care concepts such as ventilator adjustments, ABG interpretation, and weaning criteria.
- Practice thinking through next-step logic for common respiratory scenarios.
- Anticipate ethical and patient-safety elements within decision-making questions.
Quick Breakdown of the 2027 Exam Format
| Section | Question Count | Focus | Example Skills Tested |
|---|---|---|---|
| Breadth of Knowledge | 100 | Recall, Application | Concepts, procedures, and protocols |
| Depth of Clinical Judgment | 60 | Application, Analysis | Data interpretation, therapy modification, ethics |
Key Takeaway
The 2027 NBRC Respiratory Therapy Examination doesn’t just test what you know—it tests how you think.
Candidates must demonstrate the ability to recognize patient cues, interpret trends, and make safe, evidence-based decisions under pressure.
Respiratory Cram is updating all TMC and CSE-style practice simulations to align with this new exam structure, ensuring that your preparation matches the real test format.
