NPS exam guide
About the Neonatal/Pediatric Specialty (NPS) exam
The NBRC Neonatal/Pediatric Specialty examination measures respiratory-care practice across newborns, infants, children, and adolescents in general and critical-care settings. Preparation must account for gestational age, developmental anatomy and physiology, congenital disease, family-centered care, equipment sizing, neonatal transition, pediatric emergencies, and age-specific response to therapy.
MedPorium is an independent education platform and is not affiliated with or endorsed by National Board for Respiratory Care (NBRC). Exam details can change; confirm them with the official source before applying.
NPS exam format at a glance
- Questions
- 170
- 150 scored; 20 unscored
- Time
- 4 hours
- Delivery
- Computer-based testing at PSI assessment centers
Knowledge to review for the NPS exam
These foundations support the practical tasks in the official examination matrix.
Age-specific assessment and disease
- Maternal, birth, medical and surgical history; developmental examination; imaging; laboratory data; sleep findings; oxygenation; ventilation; perfusion; feeding; and growth
- Neonatal transition, prematurity, apnea, surfactant deficiency, PPHN, meconium aspiration, congenital anomalies, chronic lung disease, bronchiolitis, asthma, pediatric ARDS, and cystic fibrosis
- Cardiac, neurologic, neuromuscular, metabolic, renal, hematologic, immunologic, GI, trauma, sleep, airway, and nonpulmonary contributors to respiratory compromise
Airway, devices, and diagnostics
- Airway sizing, intubation, confirmation, securement, stoma care, speaking valves, secretion clearance, difficult airways, unplanned extubation, and congenital airway problems
- Oxygen, aerosol, PAP, humidification, suction, home ventilation, apnea monitoring, oximetry, CO2 monitoring, bronchoscopy, specimens, and blood gases
- Spirometry, MIP and MEP, FENO, peak flow, lung volumes, radiography, ultrasound, echocardiography, fluoroscopy, microbiology, chemistry, hematology, and toxicology
Critical interventions and family care
- NRP and PALS, Golden Hour, ventilation modes, waveform and mechanics analysis, prone positioning, optimal PEEP, nitric oxide, heliox, anesthetic gases, and surfactant
- VA and VV extracorporeal support, cooling, chest tubes, decompression, advanced intubation, vascular access, transport, early mobility, liberation, and VILI prevention
- Trauma-informed communication, care plans, home education, safe sleep, CPR, asthma plans, technology cleaning, palliative care, brain death, withdrawal, and organ donation
NPS examination matrix
The percentages below are the approximate exam-score weights published by National Board for Respiratory Care (NBRC). Use them to allocate study time, then adjust for your own weak areas.
53.3%
COMPETENCIES SHARED BETWEEN CRITICAL AND GENERAL CARE OF NEONATAL OR PEDIATRIC PATIENTS
The larger area covers assessment, disease mechanisms, gas exchange, pulmonary function, airway and equipment, medications, diagnostics, resuscitation, safety, teamwork, education, and home care.
- Integrate history, examination, growth, laboratory, imaging, cardiac, neurologic, feeding, oxygenation, ventilation, and sleep information
- Establish and maintain age-appropriate airways, select devices, deliver oxygen and aerosol therapy, collect and interpret respiratory data, and troubleshoot technology
- Apply resuscitation, complication prevention, disaster readiness, escalation, palliative support, culturally aware family communication, discharge education, and home planning
46.7%
COMPETENCIES SPECIFIC TO CRITICAL CARE OF NEONATAL OR PEDIATRIC PATIENTS
Apply maternal and neonatal data, specialty gases, advanced ventilation, extracorporeal support, procedures, cooling, surfactant, palliation, and critical disease management.
- Use fetal, maternal, delivery, Apgar, oxygen-challenge, and transillumination information in neonatal critical-care decisions
- Initiate and optimize advanced ventilation, mechanics, waveforms, PEEP, interaction, gas exchange, extracorporeal support, transport, mobility, and liberation
- Support invasive procedures and manage neonatal and pediatric pulmonary, airway, cardiac, neurologic, congenital, infectious, traumatic, immunocompromised, sleep, and end-of-life conditions
How to use this NPS diagnostic
The 15 questions sample both October 2025 areas. Review each miss by age group and acuity, then classify the gap as assessment, disease mechanism, gas exchange, pulmonary function, airway, equipment, diagnostics, pharmacology, resuscitation, ventilation, extracorporeal support, transport, education, palliation, or escalation.
High-yield NPS study priorities
Priority 1
State the age before the answer
Expected rates, airway anatomy, tube size, equipment, oxygen targets, fluids, disease patterns, doses, communication, and family needs change with gestational and developmental age.
Priority 2
Build a neonatal transition framework
Connect maternal and delivery history with lung fluid clearance, surfactant, fetal shunts, pulmonary vascular resistance, thermoregulation, resuscitation, and the Golden Hour.
Priority 3
Use calculated respiratory trends
Practise oxygenation index, saturation index, P/F and S/F ratios, mean airway pressure, compliance, resistance, dead space, minute ventilation, and waveform change.
Priority 4
Study discharge from the first encounter
Include caregiver skill, equipment, alarms, cleaning, medication delivery, airway emergencies, safe sleep, CPR, car-seat testing, warning signs, resources, and follow-up.
NPS exam FAQ
How many questions are on the NPS examination?
The current NPS examination contains 170 multiple-choice questions: 150 scored items and 20 unscored pretest items.
How long is the NPS examination?
Candidates currently have 4 hours to complete the examination.
Which NPS outline does this guide use?
This guide follows the NBRC detailed content outline effective October 2025. Its scored weighting is approximately COMPETENCIES SHARED BETWEEN CRITICAL AND GENERAL CARE OF NEONATAL OR PEDIATRIC PATIENTS 53.3%, COMPETENCIES SPECIFIC TO CRITICAL CARE OF NEONATAL OR PEDIATRIC PATIENTS 46.7%.
What is the largest NPS content area?
COMPETENCIES SHARED BETWEEN CRITICAL AND GENERAL CARE OF NEONATAL OR PEDIATRIC PATIENTS is the largest area at approximately 53.3% of scored content. Use that weighting to allocate study time without neglecting the remaining domains.
Who should verify eligibility for NPS?
Candidates should verify the current credential, education, experience, application, and testing requirements directly with NBRC before applying. This study page does not determine eligibility.
Does this diagnostic predict whether I will pass?
No. A 15-question diagnostic is a low-confidence baseline, not a validated pass prediction. Review every rationale and confirm patterns with larger mixed and domain-specific sets.
Is MedPorium affiliated with NBRC?
No. MedPorium is an independent education platform and is not affiliated with or endorsed by the National Board for Respiratory Care.
Review and official source
Clinical reviewer: P. I. Myers
Exam format and matrix information were checked against the NBRC NPS examination page and detailed content outline. Source reviewed October 16, 2026.
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