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
- 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.
What Topics Are Covered In The Patient Data 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 15 questions requiring recall of knowledge, 27 focused on application of knowledge and 8 asking applicants for analysis. The general topics covered include:
- Evaluating Data in the Patient Record
- Patient history
- Physical examination relative to the cardiopulmonary system
- Lines, drains, and airways
- Laboratory results
- Blood gas analysis results
- Pulmonary function testing results
- 6-minute walk test results
- Imaging study results
- Maternal and perinatal/neonatal history
- Sleep study results
- Trends in monitoring results
- Determination of a patient’s pathophysiological state
- Perform Clinical Assessment
- Interviewing a patient to assess levels of pain, smoking history, etc.
- Performing inspections to assess general appearance, characteristics of the airway, etc.
- Palpating to assess pulse, accessory muscle activity, etc.
- Performing diagnostic chest percussion
- Auscultating to assess breath sounds, blood pressure, etc.
- Reviewing chest radiographs to assess imaging, penetration, etc.
- Perform Procedures to Gather Clinical Information
- 12-lead ECG
- Noninvasive monitoring
- Peak flow
- Mechanics of spontaneous ventilation linked to tidal volume, etc.
- Blood gas sample collection
- Blood gas analysis
- Oxygen titration with exercise
- Cardiopulmonary calculations
- Hemodynamic monitoring
- Pulmonary compliance and airways resistance
- Plateau pressure
- Auto-PEEP determination
- Spontaneous breathing trial
- Apnea monitoring
- Apnea test
- Overnight pulse oximetry
- CPAP/NPPV titration during sleep
- Cuff management
- Sputum induction
- Cardiopulmonary stress testing
- 6-minute walk test
- Spirometry outside or inside a pulmonary function
laboratory - DLCO inside a pulmonary function laboratory
- Lung volumes inside a pulmonary function laboratory
- Tests of respiratory muscle strength
- Therapeutic bronchoscopy
- Evaluate Procedure Results
- 12-lead ECG
- Noninvasive monitoring
- Peak flow
- Mechanics of spontaneous ventilation linked to tidal
volume, etc. - Blood gas analysis and/or hemoximetry
- Oxygen titration with exercise
- Cardiopulmonary calculations
- Hemodynamic monitoring
- Pulmonary compliance and airways resistance
- Plateau pressure
- Auto-PEEP
- Spontaneous breathing trial
- Apnea monitoring
- Apnea test
- Overnight pulse oximetry
- CPAP/NPPV titration during sleep
- Cuff status
- Cardiopulmonary stress testing
- 6-minute walk test
- Spirometry outside or inside a pulmonary function
laboratory - DLCO inside a pulmonary function laboratory
- Lung volumes inside a pulmonary function laboratory
- Tests of respiratory muscle strength
- Recommend Diagnostic Procedures
- Testing for tuberculosis
- Laboratory tests
- Imaging studies
- Bronchoscopy
- Bronchoalveolar lavage
- Pulmonary function testing
- Noninvasive monitoring
- Blood gas analysis
- ECG
- Exhaled gas analysis
- Hemodynamic monitoring
- Sleep studies
- Thoracentesis
What Topics Are Covered in the Troubleshooting and Quality Control of Devices, 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 8 questions requiring recall of knowledge, 9 focused on application of knowledge and 3 asking applicants for analysis. The general topics covered include:
- Assemble/Troubleshoot Devices
- Medical gas delivery interfaces
- Long-term oxygen therapy
- Medical gas delivery, metering, and /or clinical
analyzing devices - CPAP / NPPV with patient interfaces
- Humidifiers
- Nebulizers
- Metered-dose inhalers, spacers, and valved holding
chambers - Dry-powder inhalers (DPI)
- Resuscitation equipment
- Mechanical ventilators
- Intubation equipment
- Artificial airways
- Suctioning equipment
- Blood analyzers
- Patient breathing circuits
- Hyperinflation devices
- Secretion clearance devices
- Heliox delivery device
- Portable spirometer
- Testing equipment in a pulmonary function laboratory
- Pleural drainage
- Noninvasive monitoring
- Bronchoscopes and light sources
- Hemodynamic monitoring devices
- Ensure Infection Prevention
- Adhering to infection prevention policies and
procedures - Adhering to disinfection policies and procedures
- Proper handling of biohazardous materials
- Adhering to infection prevention policies and
- Perform Quality Control Procedures
- Blood analyzers
- Gas analyzers
- Pulmonary function equipment for testing
- Mechanical ventilators
- 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 10 questions requiring recall of knowledge, 30 focused on application of knowledge and 30 asking applicants for analysis. The general topics covered include:
- Maintain A Patent Airway Including the Care of Artificial Airways
- Proper positioning of a patient
- Recognition of a difficult airway
- Establishing and managing a patient’s airway
- Performing tracheostomy care
- Exchanging artificial airways
- Maintaining adequate humidification
- Initiating protocols to prevent ventilator associated infections
- Performing extubation
- Perform Airway Clearance and Lung Expansion Techniques
- Postural drainage, percussion or vibration
- Suctioning
- Mechanical devices
- Assisted cough
- Hyperinflation therapy
- Inspiratory muscle training
- Support Oxygenation and Ventilation
- Initiating and adjusting oxygen therapy
- Minimizing hypoxemia
- Initiating and adjusting mask or nasal CPAP
- Initiating and adjusting mechanical ventilation settings
- Correcting patient-ventilator dyssynchrony
- Utilizing ventilator graphics
- Performing lung recruitment maneuvers
- Liberating patients from mechanical ventilation
- Administer Medications and Specialty Gases
- Aerosolized preparations
- Endotracheal instillation
- Specialty gases
- Ensure Modifications are Made to the Respiratory Care Plan
- Treatment termination
- Recommendations
- Recommendations for changes
- Recommendations for pharmacological interventions
- Utilize Evidence-Based Practice
- Classification of disease severity
- Recommendations for changes in a therapeutic plan
when indicated - Application of guidelines
- Provide Respiratory Care Techniques in High-Risk Situations
- Emergency
- Interprofessional communication
- Patient Transport
- Assist a Physician/Provider in Performing Procedures
- Intubation
- Bronchoscopy
- Specialized bronchoscopy
- Thoracentesis
- Tracheostomy
- Chest tube insertion
- Insertion of arterial or venous catheters
- Moderate sedation
- Cardioversion
- Withdrawal of life support
- Conduct Patient and Family Education
- Safety and infection control
- Home care and equipment
- Lifestyle changes
- Pulmonary rehabilitation
- Disease/condition 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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