Respiratory Therapist Multiple-Choice (TMC) Exam

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.

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.

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.

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

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

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
   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 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

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.