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).

Q

What Is The Difference Between An RRT And A CRT?

A

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.

Q

How Is The TMC Exam Constructed And Administered?

A

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.

Q

How Is The TMC Exam Content Divided?

A

The TMC exam is broken down into three main sections:

  • Patient Data
  • Troubleshooting And Quality Control Of Devices, And Infection Control
  • Initiation And Modification Of Interventions

Each has several subsections. There is some content overlap between these, as certain areas of focus can apply to numerous sections.

Q

What Topics Are Covered In The Patient Data Section?

A

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 15 questions requiring recall of knowledge, 27 focused on application of knowledge and 8 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. Lines, drains, and airways
    4. Laboratory results
    5. Blood gas analysis results
    6. Pulmonary function testing results
    7. 6-minute walk test results
    8. Imaging study results
    9. Maternal and perinatal/neonatal history
    10. Sleep study results
    11. Trends in monitoring results
    12. Determination of a patient's pathophysiological state
  2. Perform Clinical Assessment
    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. 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. Mechanics of spontaneous ventilation linked to tidal volume, etc.
    5. Blood gas sample collection
    6. Blood gas analysis
    7. Oxygen titration with exercise
    8. Cardiopulmonary calculations
    9. Hemodynamic monitoring
    10. Pulmonary compliance and airways resistance
    11. Plateau pressure
    12. Auto-PEEP determination
    13. Spontaneous breathing trial
    14. Apnea monitoring
    15. Apnea test
    16. Overnight pulse oximetry
    17. CPAP/NPPV titration during sleep
    18. Cuff management
    19. Sputum induction
    20. Cardiopulmonary stress testing
    21. 6-minute walk test
    22. Spirometry outside or inside a pulmonary function
      laboratory
    23. DLCO inside a pulmonary function laboratory
    24. Lung volumes inside a pulmonary function laboratory
    25. Tests of respiratory muscle strength
    26. Therapeutic bronchoscopy
  4. Evaluate Procedure Results
    1. 12-lead ECG
    2. Noninvasive monitoring
    3. Peak flow
    4. Mechanics of spontaneous ventilation linked to tidal
      volume, etc.
    5. Blood gas analysis and/or hemoximetry
    6. Oxygen titration with exercise
    7. Cardiopulmonary calculations
    8. Hemodynamic monitoring
    9. Pulmonary compliance and airways resistance
    10. Plateau pressure
    11. Auto-PEEP
    12. Spontaneous breathing trial
    13. Apnea monitoring
    14. Apnea test
    15. Overnight pulse oximetry
    16. CPAP/NPPV titration during sleep
    17. Cuff status
    18. Cardiopulmonary stress testing
    19. 6-minute walk test
    20. Spirometry outside or inside a pulmonary function
      laboratory
    21. DLCO inside a pulmonary function laboratory
    22. Lung volumes inside a pulmonary function laboratory
    23. Tests of respiratory muscle strength
  5. Recommend Diagnostic Procedures
    1. Testing for tuberculosis
    2. Laboratory tests
    3. Imaging studies
    4. Bronchoscopy
    5. Bronchoalveolar lavage
    6. Pulmonary function testing
    7. Noninvasive monitoring
    8. Blood gas analysis
    9. ECG
    10. Exhaled gas analysis
    11. Hemodynamic monitoring
    12. Sleep studies
    13. Thoracentesis

Q

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

A

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 8 questions requiring recall of knowledge, 9 focused on application of knowledge and 3 asking applicants for analysis. The general topics covered include:

  1. Assemble/Troubleshoot Devices
    1. Medical gas delivery interfaces
    2. Long-term oxygen therapy
    3. Medical gas delivery, metering, and /or clinical
      analyzing devices
    4. CPAP / NPPV with patient interfaces
    5. Humidifiers
    6. Nebulizers
    7. Metered-dose inhalers, spacers, and valved holding
      chambers
    8. Dry-powder inhalers (DPI)
    9. Resuscitation equipment
    10. Mechanical ventilators
    11. Intubation equipment
    12. Artificial airways
    13. Suctioning equipment
    14. Blood analyzers
    15. Patient breathing circuits
    16. Hyperinflation devices
    17. Secretion clearance devices
    18. Heliox delivery device
    19. Portable spirometer
    20. Testing equipment in a pulmonary function laboratory
    21. Pleural drainage
    22. Noninvasive monitoring
    23. Bronchoscopes and light sources
    24. Hemodynamic monitoring devices
  2. Ensure Infection Prevention
    1. Adhering to infection prevention policies and
      procedures
    2. Adhering to disinfection policies and procedures
    3. Proper handling of biohazardous materials
  3. Perform Quality Control Procedures
    1. Blood analyzers
    2. Gas analyzers
    3. Pulmonary function equipment for testing
    4. Mechanical ventilators
    5. Noninvasive monitors

Q

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

A

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 10 questions requiring recall of knowledge, 30 focused on application of knowledge and 30 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 infections
    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 therapy
    6. Inspiratory muscle training
  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. Endotracheal instillation
    3. 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 Practice
    1. Classification of disease severity
    2. Recommendations for changes in a therapeutic plan
      when indicated
    3. Application of guidelines
  7. Provide Respiratory Care Techniques in High-Risk Situations
    1. Emergency
    2. Interprofessional communication
    3. Patient Transport
  8. Assist a Physician/Provider in Performing Procedures
    1. Intubation
    2. Bronchoscopy
    3. Specialized bronchoscopy
    4. Thoracentesis
    5. Tracheostomy
    6. Chest tube insertion
    7. Insertion of arterial or venous catheters
    8. Moderate sedation
    9. Cardioversion
    10. Withdrawal of life support
  9. Conduct Patient and Family Education
    1. Safety and infection control
    2. Home care and equipment
    3. Lifestyle changes
    4. Pulmonary rehabilitation
    5. Disease/condition management

Q

How Can I Perform Well on the TMC Exam?

A

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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