What Will the 2027 RTE Questions Look Like? Breadth vs. Depth of Clinical Judgment Explained

Last updated: August 23, 2026 · Reviewed by Damon Wiseley, RRT-CPFT, B.H.S.c.

Short answer: every question on the 2027 Respiratory Therapy Examination (RTE) is an independent multiple-choice item. There are no branching simulations and no separate simulation exam. What changes is not the question format but what the questions ask you to do — roughly 100 scored items test breadth of knowledge, and roughly 60 test depth of clinical judgment.

That distinction is the single most misunderstood thing about the new exam, and it’s the one that should shape how you study. This guide breaks down both question types, shows an example of each, and explains what the change actually means for your prep.

New to the exam overall? Start with the complete 2027 RTE exam guide for format, scoring, cost, and eligibility.

What kind of questions are on the 2027 RTE?

The RTE administers 185 multiple-choice items in a four-hour sitting: 160 scored items plus 25 unscored pretest items the NBRC is trialing for future exams. Those 160 scored items split into two purposes:

Item type	What it tests	Approx. scored items
Breadth of knowledge	Range of respiratory therapy knowledge across the content domains	~100
Depth of clinical judgment	Reading a patient scenario and choosing the right information or action	~60

Both types are delivered the same way — as standalone multiple-choice questions. The difference is in what the question demands of you.

Are all RTE questions multiple choice?

Yes. The NBRC has described the RTE as being built from independent multiple-choice items. “Independent” is the important word: each question stands on its own. Your answer to one item doesn’t change what you see next, and no question unlocks or alters a later branch of the exam.

Will the RTE have CSE-style simulations?

No. The branching Clinical Simulation Examination format — where your information-gathering choices shaped the scenario as it unfolded — is being retired along with the CSE itself.

But it’s worth being precise about what’s actually gone. The simulation format disappears; the reasoning it tested does not. The clinical judgment the CSE was built to measure is now assessed through scenario-based multiple-choice items distributed throughout the single exam. You’ll still be handed a patient, still have to interpret data, and still have to decide what to do — you’ll just do it one self-contained question at a time.

Will there be select-all-that-apply questions?

The NBRC’s public description of the RTE refers to independent multiple-choice items, and there’s no public indication that select-all-that-apply (SATA) items will be part of the exam. If you’re preparing now, the sensible approach is to train on standard single-best-answer multiple-choice questions, which is what the available information describes.

As with any new exam, the NBRC continues to add detail ahead of launch, so check the current candidate handbook and content outline at nbrc.org for the most precise item-format information before your test date.

What is breadth of knowledge?

Breadth items test the range of what a respiratory therapist needs to know. They’re organized around the same content domains that have long structured NBRC testing:

• Evaluating patient data — interpreting ABGs, PFTs, imaging, waveforms, vital signs, and lab values
• Equipment and infection control — device function, troubleshooting, quality control, and infection prevention
• Initiating and modifying interventions — the heaviest domain, covering ventilator management, oxygenation strategies, airway clearance, and care-plan changes

These are the questions where knowing your normal values, device mechanics, and protocols pays off directly. A breadth item usually has a short stem and tests one piece of knowledge cleanly.

What is depth of clinical judgment?

Depth items hand you a situation rather than a fact. A typical item gives you a patient — history, presentation, vitals, maybe a lab value or a waveform description — and then asks one of two things:

1. What information do you need next? (information gathering)
2. What action do you take now? (decision making)

These items span the full range of practice the NBRC’s job analysis identified: neonatal through adult patients, in-hospital and out-of-hospital settings, routine and deteriorating presentations. The wrong answers are usually plausible — often things that are reasonable in some other context but wrong for this patient right now.

Is the new RTE easier than the TMC and CSE?

This is the question everyone is asking, and the honest answer is: the NBRC has stated its intention is not to make the credential easier or harder. The RRT standard is being carried forward, not relaxed.

What genuinely changes is the structure. One exam instead of two. One sitting instead of two scheduling headaches. One fee instead of two. All multiple-choice instead of a separate branching simulation. Those are real simplifications, and it’s fair to say the logistics get easier.

But there’s a change that cuts the other way, and it matters most for CRT-level candidates. Under the old system, a candidate could earn the CRT and simply never take the CSE — meaning they were never assessed on deep clinical judgment at all. On the RTE, clinical-judgment items are woven into the one exam, so every passing candidate has to demonstrate that reasoning, including at the CRT level.

The format is simpler. The clinical judgment isn’t.

Example of a breadth-style question

A patient’s arterial blood gas on room air shows: pH 7.48, PaCO₂ 30 mm Hg, HCO₃⁻ 23 mEq/L, PaO₂ 88 mm Hg. Which of the following best describes this result?

A. Compensated metabolic alkalosis
B. Uncompensated respiratory alkalosis
C. Partially compensated respiratory acidosis
D. Uncompensated metabolic acidosis

Correct answer: B — Uncompensated respiratory alkalosis.
The pH is alkalotic (>7.45) and the PaCO₂ is low (<35 mm Hg), which identifies a respiratory cause. The bicarbonate remains within the normal range (22–26 mEq/L), meaning metabolic compensation has not yet occurred — so the disturbance is uncompensated.

Why this is a breadth item: it tests one discrete piece of knowledge — ABG interpretation — with no patient context required beyond the values themselves. You either know the pattern or you don’t.

Example of a depth-style question

A 68-year-old patient with COPD is receiving oxygen at 4 L/min via nasal cannula for increasing dyspnea. Over the past hour the patient has become progressively more somnolent and difficult to arouse. SpO₂ is 96%. Respiratory rate has decreased from 24 to 10 breaths/min. Which of the following should the respiratory therapist do first?

A. Increase the oxygen flow to 6 L/min
B. Obtain an arterial blood gas
C. Initiate chest physiotherapy
D. Administer a bronchodilator treatment

Correct answer: B — Obtain an arterial blood gas.
The picture — rising somnolence, a falling respiratory rate, and an SpO₂ that looks reassuring — points toward CO₂ retention and worsening ventilatory status, which pulse oximetry cannot detect. An ABG identifies the PaCO₂ and pH and tells you whether ventilatory support is needed. Increasing oxygen (A) risks worsening hypercapnia and does not address ventilation. Chest physiotherapy (C) and a bronchodilator (D) treat other problems and delay recognition of impending ventilatory failure.

Why this is a depth item: nothing here can be answered from a memorized value. You have to read the trend, recognize what the normal SpO₂ is hiding, and choose the next step that actually resolves the uncertainty.

How should students prepare for depth questions?

Breadth items reward the studying you already know how to do — content review, normal values, device knowledge. Depth items reward something different, and it has to be practiced deliberately:

• Answer before you look. Read the scenario, decide your action, and commit to it before reading the options. This trains judgment instead of recognition.
• Rule out, don’t just rule in. For every question, explain why each wrong option is wrong. On the real exam the distractors are plausible, and the ability to eliminate is a separate skill from the ability to select.
• Ask “what is this data hiding?” Depth items often include a number that looks fine in isolation — like a normal SpO₂ in a patient who is retaining CO₂. Practice reading the whole picture instead of the single reassuring value.
• Work across ages and settings. Neonatal, pediatric, adult, in-hospital, out-of-hospital. If your comfort zone is adult acute care, the points you lose will be everywhere else.
• Practice in the actual format. Scenario-based multiple-choice with full rationales is the closest available proxy for the real thing.

Train the reasoning, not just the recall. Respiratory Cram’s RTE Prep Platform is built for the 2027 format — scenario-based questions with full rationales for every option, so you learn why the wrong answers are wrong. Start preparing for the RTE → respiratorycram.com

Frequently asked questions

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Ready to see the format for yourself? Work through our free RTE practice questions, then build a plan with our guide on how to study for the RTE exam. Wondering about your odds? See what RTE pass rate to expect.

Exam structure details are based on the NBRC’s published information about the 2027 Respiratory Therapy Examination. Example questions are written to illustrate item format and are not from any actual exam. For official exam information, visit nbrc.org.