Respiratory Therapist Multiple-Choice (TMC) Exam

The TMC exam is administered by The National Board for Respiratory Care (NBRC) to test applicants’ knowledge of the field and determine who should receive NBRC credentialing. Performance on the test helps determine credentialing as either a Certified Respiratory Therapist (CRT) or Registered Respiratory Therapist (RRT).

What Is The Difference Between An RRT And A CRT?

The TMC exam has two cut scores — selected points on the score scale of the test. With a low cut score, applicants receive credentials as a CRT. With a high cut score, they receive the CRT credential and become eligible for the Clinical Simulation Examination (CSE). A passing score on the CSE is a requirement for becoming an RRT.

In essence, the CRT credential is an entry credential and the RRT is an advanced credential. Both are used as the basis for state licensure in the 49 states that regulate respiratory care practices.

How Is The TMC Exam Constructed And Administered?

The TMC exam consists of 160 multiple-choice questions, with 140 scored items and 20 pretest items. Applicants must be at least 18 years old and a graduate with an associate degree from a respiratory therapy education program or a practicing CRT for several years before applying for RRT credentials.

The exam is given at designated assessment centers around the country. The examination fee is $190 for new applicants and $150 for repeat applicants. Applicants are given three hours to complete the test.

How Is The TMC Exam Content Divided?

The TMC exam is broken down into three main sections (Patient Data Evaluation And Recommendations, Troubleshooting And Quality Control Of Equipment, And Infection Control and Initiation And Modification Of Interventions), each with several subsections. There is some content overlap between these, as certain areas of focus can apply to numerous sections.

What Topics Are Covered In The Patient Data Evaluation And Recommendations Section?

Per the NBRC, the TMC exam’s Patient Data Evaluation and Recommendations section is broken into five subcategories, each with their own areas of focus. There are 12 questions requiring recall of knowledge, 26 focused on application of knowledge and 17 asking applicants for analysis. The general topics covered include:

  1. Evaluating Data in the Patient Record
    1. Patient history
    2. Physical examination relative to the cardiopulmonary system
    3. Drainage and access devices
    4. Laboratory results
    5. Blood gas analysis results
    6. Pulmonary function testing results
    7. 6-minute walk test results
    8. Cardiopulmonary stress testing results
    9. Maternal and neonatal history
    10. Metabolic study results
    11. Sleep study results
    12. Trends in monitoring results
    13. Trends in cardiac monitoring results
  2. Gathering Clinical Information
    1. Interviewing a patient to assess levels of pain, smoking history, etc.
    2. Performing inspections to assess general appearance, characteristics of the airway, etc.
    3. Palpating to assess pulse, accessory muscle activity, etc.
    4. Performing diagnostic chest percussion
    5. Auscultating to assess breath sounds, blood pressure, etc.
    6. Lateral neck radiographs
    7. Reviewing chest radiographs to assess imaging, penetration, etc.
  3. Perform Procedures to Gather Clinical Information
    1. 12-lead ECG
    2. Noninvasive monitoring
    3. Peak flow
    4. Tidal volume, minute volume and vital capacity
    5. Screening spirometry
    6. Blood gas sample collection
    7. Blood gas analysis
    8. 6-minute walk test
    9. Oxygen titration with exercise
    10. Cardiopulmonary calculations
    11. Hemodynamic monitoring
    12. Pulmonary compliance and airways resistance
    13. Maximum inspiratory and expiratory pressures
    14. Plateau pressure
    15. Auto-PEEP determination
    16. Spontaneous breathing trial
    17. Apnea monitoring
    18. Overnight pulse oximetry
    19. CPAP/NPPV titration during sleep
    20. Tracheal tube cuff pressure and/or volume
    21. Sputum induction
    22. Cardiopulmonary stress testing
    23. Pulmonary function testing
  4. Evaluate Procedure Results
    1. 12-lead ECG
    2. Noninvasive monitoring
    3. Peak flow
    4. Tidal volume, minute volume and vital capacity
    5. Screening spirometry
    6. Blood gas analysis
    7. 6-minute walk test
    8. Oxygen titration with exercise
    9. Cardiopulmonary calculations
    10. Hemodynamic monitoring
    11. Pulmonary compliance and airways resistance
    12. Maximum inspiratory and expiratory pressures
    13. Plateau pressure
    14. Auto-PEEP determination
    15. Spontaneous breathing trial
    16. Apnea monitoring
    17. Overnight pulse oximetry
    18. CPAP/NPPV titration during sleep
    19. Tracheal tube cuff pressure and/or volume
    20. Sputum induction
    21. Cardiopulmonary stress testing
    22. Pulmonary function testing
  5. Recommend Diagnostic Procedures
    1. Skin testing
    2. Blood tests
    3. Imaging studies
    4. Bronchoscopy
    5. Bronchoalveolar lavage
    6. Sputum Gram stain, culture and sensitivities
    7. Pulmonary function testing
    8. Noninvasive monitoring
    9. Blood gas analysis
    10. ECG
    11. Exhaled gas analysis
    12. Hemodynamic monitoring
    13. Sleep studies
    14. Thoracentesis

What Topics Are Covered in the Troubleshooting and Quality Control of Equipment, and Infection Control Section?

Per the NBRC, the TMC exam’s Troubleshooting and Quality Control Of Equipment, and Infection Control section is broken into three subcategories, each with their own areas of focus. There are seven questions requiring recall of knowledge, 10 focused on application of knowledge and three asking applicants for analysis. The general topics covered include:

  1. Assemble and Troubleshoot Equipment
    1. Oxygen administration devices
    2. CPAP devices
    3. Humidifiers
    4. Nebulizers
    5. Metered-dose inhalers
    6. Dry powder inhalers
    7. Resuscitation devices
    8. Mechanical ventilators
    9. Intubation equipment
    10. Artificial airways
    11. Suctioning equipment
    12. Gas delivery, metering and clinical analyzing devices
    13. Blood analyzers
    14. Patient breathing circuits
    15. Incentive breathing devices
    16. Airway clearance devices
    17. Heliox delivery device
    18. Nitric oxide delivery device
    19. Spirometers
    20. Pleural drainage device
    21. Noninvasive monitoring devices
    22. Gas analyzers
    23. Bronchoscopes and light sources
    24. Hemodynamic monitoring devices
  2. Ensure Infection Control
    1. Using high-level disinfection techniques
    2. Selecting appropriate agents and techniques for surface disinfection
    3. Monitoring effectiveness of sterilization procedures
    4. Proper handling of biohazardous materials
    5. Adhering to infection control policies and procedures
  3. Perform Quality Control Measures
    1. Gas analyzers
    2. Blood gas analyzers and hemoximeters
    3. Point-of-care analyzers
    4. Pulmonary function equipment
    5. Mechanical ventilators
    6. Gas metering devices
    7. Noninvasive monitors

What Topics Are Covered in The Initiation and Modification of Interventions Section?

Per the NBRC, the TMC exam’s Initiation and Modification of Interventions section is broken into nine subcategories, each with their own areas of focus. There are 12 questions requiring recall of knowledge, 25 focused on application of knowledge and 28 asking applicants for analysis. The general topics covered include:

  1. Maintain A Patent Airway Including the Care of Artificial Airways
    1. Proper positioning of a patient
    2. Recognition of a difficult airway
    3. Establishing and managing a patient’s airway
    4. Performing tracheostomy care
    5. Exchanging artificial airways
    6. Maintaining adequate humidification
    7. Initiating protocols to prevent ventilator associated pneumonia
    8. Performing extubation
  2. Perform Airway Clearance and Lung Expansion Techniques
    1. Postural drainage, percussion or vibration
    2. Suctioning
    3. Mechanical devices
    4. Assisted cough
    5. Hyperinflation
    6. Inspiratory muscle training techniques
  3. Support Oxygenation and Ventilation
    1. Initiating and adjusting oxygen therapy
    2. Minimizing hypoxemia
    3. Initiating and adjusting mask or nasal CPAP
    4. Initiating and adjusting mechanical ventilation settings
    5. Correcting patient-ventilator dyssynchrony
    6. Utilizing ventilator graphics
    7. Performing lung recruitment maneuvers
    8. Liberating patients from mechanical ventilation
  4. Administer Medications and Specialty Gases
    1. Aerosolized preparations
    2. Dry powder preparations
    3. Endotracheal instillation
    4. Specialty gases
  5. Ensure Modifications are Made to the Respiratory Care Plan
    1. Treatment termination
    2. Recommendations
    3. Recommendations for changes
    4. Recommendations for pharmacological interventions
  6. Utilize Evidence-Based Medicine Principles
    1. Determination of a patient’s pathophysiological state
    2. Recommendations for changes in a therapeutic plan when indicated
    3. Application of evidence-based or clinical practice guidelines
  7. Provide Respiratory Care Techniques in High-Risk Situations
    1. Emergency
    2. Patient Transport
  8. Assist a Physician/Provider in Performing Procedures
    1. Intubation
    2. Bronchoscopy
    3. Thoracentesis
    4. Tracheostomy
    5. Chest tube insertion
    6. Insertion of arterial or venous catheters
    7. Moderate sedation
    8. Cardioversion
    9. Cardiopulmonary exercise testing
    10. Withdrawal of life support
  9. Initiate and Conduct Patient and Family Education
    1. Safety and infection control
    2. Home care and equipment
    3. Smoking cessation
    4. Pulmonary rehabilitation
    5. Disease management

How Can I Perform Well on the TMC Exam?

With so many technical terms to be familiar with, preparing for the TMC exam necessitates the use of flash cards made specifically for CRT and RRT candidates. Beyond the use of flash cards, regular use of a tailor-made practice test should put test takers in the best possible position to succeed on the TMC exam.

Mometrix offers an excellent study guide with included practice test. You can also buy our flashcards to get that extra practice in.

TMC Study Guide

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