NBRC TMC Exam Prep: Final-Window Plan and 30 Practice Questions
For NBRC TMC exam prep, answer each of these 30 original, unofficial questions, then open its explanation. This set follows the TMC outline used through December 31, 2026; the new RT Examination becomes available January 4, 2027.
Practice questions
Patient Data (Section I)
TMC-01 · IA · Application A 54-year-old man is drowsy after IV opioids following surgery. Room-air ABG: pH 7.28, PaCO₂ 58 mmHg, HCO₃⁻ 26 mEq/L, PaO₂ 62 mmHg. Which interpretation is correct?
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A. The pH is acidemic and the PaCO₂ is high, so the primary problem is respiratory. In acute respiratory acidosis, HCO₃⁻ rises only about 1 mEq/L for each 10 mmHg rise in PaCO₂ — an expected value near 26, which is what you see. B is wrong because chronic compensation raises HCO₃⁻ much more (roughly 3.5–4 per 10 mmHg, so around 30) and pulls the pH closer to normal. C would require a primary fall in HCO₃⁻. D would require evidence of an additional metabolic acidosis; this HCO₃⁻ matches the expected acute respiratory response. Source: ATS, Interpretation of ABGs, Steps 2–4; respiratory-acidosis compensation rows.
TMC-02 · ID · Analysis A 30-year-old breathing room air at sea level has PaO₂ 60 mmHg and PaCO₂ 40 mmHg. Using barometric pressure 760 mmHg, PH₂O 47 mmHg, and R 0.8, what is the A–a gradient and what does it suggest?
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B. PAO₂ = 0.21 × (760 − 47) − 40/0.8 = 149.7 − 50 ≈ 100 mmHg. A–a = 100 − 60 ≈ 40 mmHg, well above normal for a young adult, pointing to V/Q mismatch, shunt, or a diffusion problem. A describes the pattern of pure hypoventilation, where the gradient stays normal — but this PaCO₂ is normal. C overstates the number and the conclusion; a widened gradient has several possible causes. D: hemoglobin isn't part of the alveolar gas equation. Source: Stanford Anesthesiology CA-1 Tutorial Textbook, Hypoxemia, PDF p. 57: Causes of Hypoxemia and Equations.
TMC-03 · IA · Application A 66-year-old former smoker with chronic exertional dyspnea has post-bronchodilator spirometry: FEV₁/FVC 0.58, FEV₁ 55% of predicted. Using GOLD airflow-obstruction grades, how should this be classified?
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A. A post-bronchodilator FEV₁/FVC below 0.70 confirms persistent airflow obstruction, and an FEV₁ of at least 50% but under 80% predicted is GOLD grade 2. B: a normal or high ratio with reduced FVC can suggest restriction; confirmation requires a reduced total lung capacity. The low ratio here establishes airflow obstruction by GOLD criteria. C: GOLD 3 is FEV₁ at least 30% but under 50%. D: 0.50 isn't the threshold; 0.70 is. Source: GOLD 2026 Pocket Guide, Figure 2.10, printed p. 17 / PDF p. 20; diagnostic framework p. 8; ERS/ATS interpretive technical standard, Restrictive Impairments, PDF p. 22; Mixed Ventilatory Impairments, p. 23.
TMC-04 · IB · Analysis A ventilated patient's SpO₂ suddenly falls from 95% to 80%. Peak pressure rises, BP is 78/40, the left chest is hyperresonant with absent breath sounds, and the trachea is shifted to the right. What is the most likely problem?
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A. Absent breath sounds plus hyperresonance on one side, tracheal shift away from that side, and hypotension is tension pneumothorax — it needs immediate decompression. B also silences the left side, but it doesn't cause hyperresonance or push the trachea away. C: significant volume-loss atelectasis can cause dullness to percussion and pull the trachea toward the affected side. D affects both lungs, not one side. Source: New Jersey EMS clinical protocols, Needle Thoracostomy, p. 180; Apgar scale, p. 64.
TMC-05 · IB · Application On an adult's chest film with the head and neck neutral, the endotracheal tube tip sits 1 cm above the carina. What should you recommend?
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A. The tip should sit several centimeters above the carina with the head neutral, and head flexion or extension can shift its position. At 1 cm, head flexion or patient movement can push it into the right mainstem bronchus, so pull back a few centimeters and recheck. B moves it closer to the mainstem. C is wrong for the reason above. D is unnecessary for the position problem described; repositioning and reconfirmation address it. Source: European Society of Radiology, ECR educational exhibit C-3024, Findings and procedure details → Endotracheal tube, items 2–3.
TMC-06 · ID · Analysis A passive patient on volume control has delivered Vt 500 mL, constant flow 60 L/min, and measured total PEEP 5 cmH₂O, with no intrinsic PEEP. These values remain unchanged. Over an hour the peak pressure rises from 30 to 40 cmH₂O while plateau pressure measured during a valid inspiratory hold stays at 25. What best explains this?
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B. Static respiratory-system compliance is unchanged at 500 ÷ (25 − 5) = 25 mL/cmH₂O. Resistance rose from (30 − 25) ÷ 1 L/s = 5 to (40 − 25) ÷ 1 = 15 cmH₂O/(L/s). With these measurements, the increased peak-to-plateau difference indicates increased resistance in the patient, artificial airway, or circuit. A would raise plateau too. C would increase measured total PEEP; total PEEP is unchanged here. D would be suggested by a leak and reduced returned volume, rather than this isolated rise in resistive pressure. Source: SOCCA ICU Residents’ Guide, Chapter 16, Mechanics, printed p. 74 / PDF p. 84; AARC Patient–Ventilator Assessment guideline, Driving Pressure, p. 1046; PICO 1 implementation, p. 1047; PICO 4, p. 1051.
TMC-07 · IE · Application A house-fire victim is confused and complains of a headache. SpO₂ reads 99% on a nonrebreather. What should you recommend?
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C. Conventional two-wavelength pulse oximeters cannot reliably distinguish carboxyhemoglobin from oxyhemoglobin, so SpO₂ can look normal in carbon monoxide poisoning. A CO-oximeter measures COHb directly. A is dangerous: high FiO₂ speeds CO elimination. B doesn't measure COHb. D doesn't fix the measurement problem. Venous blood can also be used for COHb measurement. Source: CDC carbon monoxide clinical guidance, Management; Confirmation of Diagnosis.
TMC-08 · ID · Application Two minutes into a monitored spontaneous breathing trial, a patient's rate is 32/min and spontaneous Vt is 250 mL. What is the rapid shallow breathing index, and what does it suggest?
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D. RSBI = f ÷ Vt in liters = 32 ÷ 0.25 = 128. This exceeds the historical 105 threshold, but RSBI alone does not establish weaning failure or extubation readiness. A reverses the calculation and uses the wrong volume units. B gives the correct number but an unsupported extubation conclusion. C is a miscalculation. One current-practice note: AARC's 2024 guideline suggests an RSBI isn't needed to decide whether a patient is ready for an SBT, so treat it as one data point, not a gate. Source: AARC SBT guideline, PICO 1, PDF pp. 4–5.
TMC-09 · IB · Application (neonatal) At 1 minute, a newborn has HR 80/min, slow irregular breathing, some flexion of the extremities, a grimace to stimulation, and a pink body with blue hands and feet. What's the Apgar score?
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B. Each sign scores 1: HR below 100 (1), slow/irregular respirations (1), some flexion (1), grimace (1), acrocyanosis (1) = 5. C and D would need some signs scored at 2, such as a good cry, active motion, a vigorous cry or cough to stimulation, or a completely pink baby. A undercounts. Apgar scoring must not delay indicated neonatal resuscitation. Source: New Jersey EMS clinical protocols, Needle Thoracostomy, p. 180; Apgar scale, p. 64; AAP/ACOG, The Apgar Score, Introduction; Apgar Score and Resuscitation.
TMC-10 · IA · Recall An adult with established obstructive sleep apnea has an apnea–hypopnea index (AHI) of 32 events per hour. How is its severity classified?
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D. For adults, AHI 5 to under 15 is mild, 15 to under 30 moderate, and 30 or more severe. An AHI of 32 falls in the severe range, so the normal, mild, and moderate choices do not fit. Source: AASM Quality Measure 277, Rationale, pp. 2–3.
Devices, Quality Control, and Infection Control (Section II)
TMC-11 · IIA · Application An E cylinder reads 2,000 psig. The patient needs a continuous flow of 4 L/min. Using an E-cylinder factor of 0.28 L/psi, about how long will it last until empty?
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B. Duration = psig × factor ÷ flow = 2,000 × 0.28 ÷ 4 = 140 minutes (2 hours 20 minutes). For a clinical duration estimate, subtract the reserve required by the local protocol first — with an assumed 200 psig reserve, it's 126 minutes. D forgets the cylinder factor (2,000 ÷ 4). C divides by 2 L/min instead of 4. A uses a factor far smaller than an E cylinder's. Source: Tampa General, Oxygen: Do You Have Enough?, Cylinder table p. 2; duration formula p. 3.
TMC-12 · IIA · Analysis For this idealized air-entrainment calculation, assume the air-to-oxygen ratio stays constant at the 35% setting. Oxygen input is 6 L/min and the patient's estimated peak inspiratory demand is 40 L/min. Which change raises calculated total flow above that demand without changing the calculated FiO₂?
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A. At 35%, the air-to-oxygen ratio is (100 − 35) ÷ (35 − 21) ≈ 4.6:1, so total flow is about 6 × 5.6 ≈ 34 L/min — below the patient's 40 L/min demand, so additional room-air entrainment can dilute the delivered FiO₂. At 8 L/min, total flow is about 45 L/min with the FiO₂ unchanged. B lowers the entrainment ratio and therefore total flow at unchanged oxygen input. C gives a variable, uncontrolled FiO₂. D ignores the flow deficit. For clinical use, follow the specific device’s labeled flow settings; the cited manufacturer table lists 8 L/min for its 35% setting. Source: Intersurgical Silente Venturi information sheet, p. 2, flow table and Ease of use.
TMC-13 · IIA · Application A patient with severe COPD cannot generate the inspiratory flow required by her dry powder inhaler. Her prescribed medication is available in a suitable pressurized MDI formulation. What should you recommend?
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C. A DPI depends on sufficient device-specific inspiratory effort to disperse the powder; when the patient cannot generate it, a suitable alternative is an MDI plus a valved holding chamber (or a nebulizer). A: a spacer doesn't fix the problem — the device still depends on the patient's inspiratory effort. B: slowing inhalation will not correct insufficient inspiratory flow for this DPI. D: exhaling into a DPI can displace the dose and adds moisture. Source: AARC Guide to Aerosol Delivery Devices, 5th edition, printed pp. 36–39, especially p. 39; device selection p. 46.
TMC-14 · IIB · Recall For a ventilator circuit in continued use on one patient, which policy best reflects infection-prevention guidance?
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C. Routine scheduled circuit changes don't reduce ventilator-associated pneumonia; change a circuit when it's visibly soiled or not working. Routine scheduled changes solely to prevent VAP (A, B, D) add cost without demonstrated benefit; follow manufacturer instructions if they specify a change. Source: SHEA/IDSA/APIC pneumonia prevention update, Adult essential practices → Maintain ventilator circuits.
TMC-15 · IIC · Application A blood gas analyzer's control falls outside its acceptable limits for PCO₂. What should happen next?
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D. An out-of-control QC result means affected patient results can't be trusted until the problem is found and corrected and controls are back in range. A releases unreliable data. B averages error rather than fixing it. C hides the problem. Document corrective actions and evaluate potentially affected patient results from the unacceptable run and since the last acceptable run. Source: AARC Blood Gas Analysis and Hemoximetry guideline, §8.3.1.3, printed p. 1698 / PDF p. 5; 42 CFR §493.1256, paragraph (f); 42 CFR §493.1282, paragraph (b)(2).
Initiation and Modification of Interventions (Section III)
TMC-16 · IIIC · Application A 5'10" (70-inch) man weighing 100 kg is intubated for ARDS. Using ARDSNet's lung-protective approach, what's the target tidal volume?
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B. Use predicted body weight, not actual weight: PBW = 50 + 2.3 × (70 − 60) = 73 kg. At 6 mL/kg, Vt ≈ 438 mL. A is 5 mL/kg rather than the 6 mL/kg target asked for here. C uses actual weight. D is 10 mL/kg PBW. Source: NHLBI ARDS Network FACTT protocol (2001), PDF pp. 44–46: C.1.2, plateau/pH management and lower-PEEP/FiO2 table; AARC Patient–Ventilator Assessment guideline, Driving Pressure, p. 1046; PICO 1 implementation, p. 1047; PICO 4, p. 1051.
TMC-17 · IIIE · Analysis That ARDS patient, now at 6 mL/kg PBW, has a plateau pressure of 33 cmH₂O measured during a passive inspiratory hold and a pH of 7.32. What does the ARDSNet protocol call for?
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A. The plateau goal is ≤30 cmH₂O. With pH 7.32 and plateau pressure 33, reduce Vt by 1 mL/kg PBW and reassess; further reductions may be needed, down to 4 mL/kg PBW. Respiratory-rate changes follow the pH algorithm rather than occurring automatically after every Vt reduction. B is not the protocol’s response to an elevated plateau pressure. C uses the wrong plateau-pressure goal. D can increase overdistension. Source: NHLBI ARDS Network FACTT protocol (2001), PDF pp. 44–46: C.1.2, plateau/pH management and lower-PEEP/FiO2 table.
TMC-18 · IIIE · Application A patient without lung injury, recovering from an opioid overdose, is fully controlled on volume-control ventilation with an appropriate Vt and rate of 12/min. ABG: pH 7.28, PaCO₂ 60 mmHg. Assume Vt, dead space, and CO₂ production remain unchanged. If the clinician selects a PaCO₂ target of 40 mmHg, what rate does the inverse-proportion calculation estimate?
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C. Under the stated assumptions, estimated new rate = 12 × 60 ÷ 40 = 18/min. A and B predict a PaCO₂ above the selected target; D predicts a PaCO₂ below it. This estimate requires reassessment of ventilation and a follow-up ABG after a setting change. Source: Fanshawe College, Breathe Easy: RT Student Resource for Mechanical Ventilation, §9.7, How much do I change settings by?.
TMC-19 · IIIC · Application An ARDS patient is on FiO₂ 0.60 and PEEP 8 cmH₂O. The team plans to keep FiO₂ at 0.60 while matching the ARDSNet lower-PEEP/FiO₂ table. Which change matches that table?
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B. On the lower-PEEP table, FiO₂ 0.6 pairs with PEEP 10 — so PEEP 8 is low for this FiO₂. A changes the FiO₂ instead of matching the requested pair. C changes tidal volume, not the table’s PEEP/FiO₂ pairing. D moves PEEP farther from the listed value. This question tests the specified protocol table; it does not establish a universal first response to acute hypoxemia. Source: NHLBI ARDS Network FACTT protocol (2001), PDF pp. 44–46: C.1.2, plateau/pH management and lower-PEEP/FiO2 table.
TMC-20 · IIIE · Analysis An alert, cooperative adult with a COPD exacerbation can protect the airway and is hemodynamically stable. Despite standard medical treatment, the patient is on 2 L/min nasal cannula: SpO₂ 90%, RR 28 with accessory muscle use, pH 7.29, PaCO₂ 70 mmHg. There is no immediate deterioration requiring intubation. What should you recommend?
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B. Acute hypercapnic respiratory acidosis (pH ≤7.35) in a COPD exacerbation is the classic indication for bilevel NIV, which reduces intubation and mortality. A raises FiO₂ without fixing ventilation and can worsen CO₂ retention. C is not the first step for the stable patient described, but deterioration or NIV failure requires prompt reassessment for intubation. D suppresses the drive that's keeping him ventilating. Source: Official ERS/ATS NIV guideline, PDF pp. 5–6: COPD respiratory-acidosis recommendation and implementation.
TMC-21 · IIIF · Application What SpO₂ target fits an adult patient receiving oxygen during a COPD exacerbation?
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C. AARC's 2022 adult oxygen guideline uses 88–92% for patients with COPD who need oxygen — to correct hypoxemia while limiting the risk from excessive oxygen and worsening hypercapnia. B (94–98%) is AARC's target for most other hospitalized adults; the COPD qualifier is what changes the answer. A leaves the patient hypoxemic. D raises the risk of CO₂ retention. Source: AARC adult oxygen guideline, Table 2, p. 120; Table 3, p. 122.
TMC-22 · IIIF · Application An adult with a severe asthma exacerbation in the emergency department hasn't improved after initial albuterol. Ipratropium and systemic corticosteroids have not yet been given. What's the best recommendation?
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A. For severe exacerbations in acute care, guidelines support adding ipratropium to a short-acting beta-agonist and giving systemic corticosteroids early. B is LABA monotherapy, not an appropriate substitute for this acute regimen. C, inhaled corticosteroids alone, does not replace the indicated bronchodilator and systemic-steroid treatment. D is not part of the recommended acute regimen. Source: GINA Summary Guide, p. 35, exacerbations in acute care; p. 43, short-acting antimuscarinics.
TMC-23 · IIIB · Application An alert, cooperative postoperative patient has been prescribed incentive spirometry after individual assessment. Which accompanying plan best matches evidence-based lung expansion guidance?
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A. AARC's incentive spirometry guideline recommends against using incentive spirometry by itself for routine postoperative prevention, and recommends it as part of a bundle with deep breathing, directed coughing, early mobilization, and optimal pain control. This patient is alert and cooperative, so they can do it. B is the "alone" approach the guideline recommends against. C: immobility works against lung expansion. D targets secretion clearance rather than providing the recommended lung-expansion bundle. This does not mean incentive spirometry is routinely needed after every operation; the same guideline advises against routine use to prevent atelectasis after upper abdominal surgery. Source: AARC Incentive Spirometry guideline, p. 1603, recommendations 14.1–14.4.
TMC-24 · IIIB · Application During endotracheal suctioning, an adult patient's heart rate drops from 92 to 48/min and SpO₂ falls from 95% to 85%. What should you do?
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D. Bradycardia and desaturation are reasons to stop immediately and restore oxygenation. A prolongs the cause. B increases mucosal trauma and lung derecruitment. C isn't routinely recommended and doesn't address the emergency. The adult suctioning policy cited below directs stopping suctioning, ensuring oxygenation, and team reassessment for these adverse responses. Source: Royal Victoria Regional Health Centre, Suctioning the Adult Patient, p. 6 ETT step 6; p. 11 Appendix II, hypoxemia and cardiac-arrhythmia rows; AARC Artificial Airway Suctioning guideline, pp. 261–264: adverse effects, oxygenation and saline discussion.
TMC-25 · IIIA · Application An intubated adult's cuff pressure measures 38 cmH₂O. What should you do?
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D. Keep cuff pressure at about 20–30 cmH₂O: excessive pressure can impair tracheal mucosal blood flow, while insufficient pressure can permit leakage and microaspiration. Check it with a cuff manometer — AARC's 2024 guideline strongly recommends a manometer because palpation and minimal-leak techniques are inaccurate. A and B risk ischemic injury. C can cause a substantial leak and loss of the cuff seal. Source: AARC Patient–Ventilator Assessment guideline, Driving Pressure, p. 1046; PICO 1 implementation, p. 1047; PICO 4, p. 1051.
TMC-26 · IIID · Application A patient with cystic fibrosis is prescribed dornase alfa (Pulmozyme) by nebulizer and also receives nebulized albuterol. Which preparation follows the dornase alfa label?
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D. The label directs users not to dilute dornase alfa or mix it with other drugs in the nebulizer, and it specifies recommended delivery systems. A and B change the labeled preparation; C assumes unsupported device compatibility. Source: DailyMed, Pulmozyme prescribing information, §2.2, Administration Instructions.
TMC-27 · IIIC · Analysis A passive patient with COPD is on controlled volume ventilation with constant inspiratory flow. Expiratory flow doesn't return to zero before the next breath. With tidal volume and rate otherwise unchanged, which change increases the time available for exhalation?
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C. Flow that doesn't reach zero indicates incomplete exhalation and suggests air trapping (auto-PEEP). In constant-flow volume control, increasing inspiratory flow delivers the same Vt sooner, leaving more expiratory time at the same rate. Increasing expiratory time can reduce gas trapping; also address the underlying airflow obstruction. A, B, and D all shorten expiratory time or add volume to trap. Source: ATS, Don’t Hold Your Breath, Discussion.
TMC-28 · IIIG · Application An intubated adult is stable on the planned transport ventilator before an intrahospital transfer. Which additional preparation is required before departure?
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C. A working transport ventilator does not remove the need for backup ventilation and an adequate gas supply. A removes the backup; B leaves the oxygen supply unverified; D removes a safety warning. Source: AARC transport position statement, p. 1, preparation/equipment and item 3; p. 2, item 6; AARC In-Hospital Transport guideline, p. 722, §§10.1.1–10.1.4.
TMC-29 · IIIC · Application (neonatal) After warming, drying, and stimulating, a newborn is still apneic with a heart rate of 80/min. What's next?
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D. Apnea or HR below 100 after the initial steps calls for positive-pressure ventilation, started within the first minute of life. A: compressions come only if HR stays below 60 despite 30 seconds of ventilation that inflates the lungs. B delays ventilation. C doesn't help a baby who isn't breathing. Source: AHA/AAP Neonatal Resuscitation guidelines, §11.1 Ventilatory Support; §13.1 Chest Compressions.
TMC-30 · IIII · Application A patient going home on oxygen says he'll "just smoke on the porch with the cannula on." What's the most important teaching point?
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C. Oxygen makes materials ignite more easily and burn faster; smoking while using oxygen causes serious burns and fires. Lowering flow (A), being outdoors (B), or switching interfaces (D) doesn't remove the fire risk. Source: American Lung Association, Using Oxygen Safely, Opening explanation; Tips for Using Oxygen Safely.
How to use your score
This set contains 10 Patient Data questions, 5 Devices/QC/Infection Control questions, and 15 Interventions questions. Count one point for each correct answer, with no partial credit; record unanswered items separately and include all 30 in the denominator.
Tally by section: Patient Data (01–10), Devices/QC/Infection Control (11–15), Interventions (16–30). Your missed items suggest what to review in your next study block. Your result is "X of 30 on this set" — performance on these items, not an NBRC score. Thirty questions can't predict a pass or a cut score, and 5 or 10 items can't measure a whole section precisely. Use NBRC’s free TMC practice examination for official format familiarization; a full timed practice exam can help you rehearse pacing and endurance. Neither turns this 30-question result into a validated pass prediction. If you redo the set later, remember you've seen these questions; a higher score partly reflects familiarity.
Turn a missed answer into the next task
For every miss, write down four things: the clue in the question that decides it, why your answer looked right, the corrected rule and its source, and when you'll check yourself again. Then sort the miss into one of four types — concept gap, data interpretation, calculation/units, or unsupported assumption — so you can see which kind of mistake keeps repeating.
| Question | Type of miss | Deciding clue | Corrected rule | Next task | Recheck |
|---|---|---|---|---|---|
| TMC-16 | Calculation/units: used actual weight | "ARDSNet," "lung-protective" | Vt uses predicted body weight: 50 + 2.3 × (70 − 60) = 73 kg; × 6 mL/kg = 438 mL | Rework two PBW problems with different heights, writing the denominator first | Next session, without notes |
| Your next miss |
Where the 140 scored points are
The TMC has 160 questions in 3 hours: 140 count, 20 are unscored pretest items you can't identify, so treat every question as live. That's 67.5 seconds per question, or about 68 seconds. Scores are raw (one point per correct scored response); NBRC's international candidates FAQ lists the high cut — the score that meets the score requirement for CSE eligibility, provided you also meet its admission requirements — as 92 or above, about 66% of the 140 scored items.
Here's the official TMC outline (effective January 2020 through December 31, 2026), sorted by how many points each area carries. Use the counts alongside your error log to decide what to study next.
| Rank | Outline area | Scored items | What it actually tests |
|---|---|---|---|
| 1 | IIIE. Ensure modifications are made to the care plan | 18 | Recommending changes: ventilator settings, therapy changes, drug changes, stopping treatment |
| 2 | IIA. Assemble / troubleshoot devices | 15 | O₂ delivery, CPAP/NIV, humidifiers, nebulizers, MDIs/DPIs, resuscitation bags, ventilators, suction |
| 2 | IIIC. Support oxygenation and ventilation | 15 | O₂ therapy, CPAP, initial vent settings, dyssynchrony, graphics, recruitment, liberation |
| 4 | IC. Perform procedures to gather clinical information | 12 | ECG, noninvasive monitoring, blood gas sampling, calculations, SBT, apnea test for brain-death determination, 6MWT, spirometry |
| 5 | IA. Evaluate data in the patient record | 10 | History, labs, ABGs/hemoximetry, PFTs, imaging, sleep studies, monitoring trends |
| 5 | IB. Perform clinical assessment | 10 | Interview, inspection, palpation, percussion, auscultation, chest film review |
| 5 | ID. Evaluate procedure results | 10 | Interpreting ECG, blood gases, calculations, compliance/resistance, auto-PEEP, SBT, PFTs |
| 5 | IIIA. Maintain a patent airway | 10 | Positioning, difficult airway, artificial airway care, trach care, extubation |
| 9 | IE. Recommend diagnostic procedures | 8 | TB testing, labs, imaging, bronchoscopy/BAL, PFTs, sleep studies, thoracentesis |
| 10 | IIIF. Evidence-based practice | 6 | Disease severity classification; ARDSNet, NAEPP, GOLD-style protocols |
| 11 | IIIB. Airway clearance and lung expansion | 5 | Postural drainage, suctioning, devices, assisted cough, hyperinflation |
| 11 | IIIG. High-risk situations | 5 | Cardiopulmonary emergencies excluding CPR, disasters, rapid response, transport |
| 13 | IIID. Medications and specialty gases | 4 | Aerosolized drugs, heliox, inhaled nitric oxide |
| 13 | IIIH. Assist a provider with procedures | 4 | Intubation, bronchoscopy, thoracentesis, chest tubes, lines, cardioversion |
| 15 | IIC. Quality control | 3 | Blood gas analyzers, gas analyzers, PFT equipment, ventilators, monitors |
| 15 | IIII. Patient and family education | 3 | Safety, home care, rehab, disease management |
| 17 | IIB. Infection prevention | 2 | Infection control and disinfection policies, biohazards |
Section totals: I. Patient Data 50 · II. Troubleshooting and Quality Control of Devices, and Infection Control 20 · III. Initiation and Modification of Interventions 70. By cognitive level: 33 recall, 66 application, 41 analysis — so about three of every four points ask you to use a fact, not just recall it. Expect a handful of pediatric and neonatal items (the outline targets 4 pediatric and 3 neonatal).
The counts tell you where the points are, not which topics will feel hardest. If ventilator management is your weak spot, give it focused study time. IIIC and IIIE together are 33 of the 140 points, but those categories include ventilation and other interventions; they are not 33 guaranteed ventilator-management questions.
The three domains account for 35.7%, 14.3%, and 50.0% of the 140 scored items. The 30-question set above contains 10, 5, and 15 questions respectively; it does not reproduce every subdomain, cognitive level, or patient-age specification. Its topic and cognitive labels are editorial mappings to the outline, not NBRC classifications of these unofficial items.
Your study plan for the weeks left
Assumption: about 10–12 study hours a week alongside work or clinicals. If you have more time, add timed question sets, not more passive reading.
Six-week plan (start Monday, November 2 → test Friday, December 11)
| Week | Dates | Focus | Do this |
|---|---|---|---|
| 1 | Nov 2–8 | Book it + baseline | Apply and schedule your test date this week. Use NBRC’s free TMC practice examination for format familiarization. Do the 30 questions above and log every miss by outline area. Start blood gases: interpretation, compensation, A–a gradient, CO-oximetry. |
| 2 | Nov 9–15 | Patient Data (I) | PFT interpretation, chest imaging, assessment findings, sleep study basics, ECG rhythms, neonatal assessment. One calculation drill session: compliance, resistance, RSBI, A–a, O₂ cylinder duration, entrainment ratios. |
| 3 | Nov 16–22 | Ventilation (IIIC, IIIE) | Initial settings, lung-protective ventilation, ARDSNet tables, adjusting for ABGs, graphics (auto-PEEP, dyssynchrony), weaning/SBT criteria. Use your recorded errors to decide which of these applied skills needs another session. |
| 4 | Nov 23–29 | Rest of III (Thanksgiving week — lighter) | Airway care and extubation, airway clearance, aerosol drugs and specialty gases, GOLD/asthma-guideline decisions, non-CPR cardiopulmonary emergencies, transport preparation, and neonatal ventilation basics, assisting with procedures, patient education. |
| 5 | Nov 30–Dec 6 | Devices (II) + mixed sets | Troubleshooting every device in IIA, infection control, QC rules. Redo the on-page set in two mixed 15-question blocks with answers closed, at about 68 seconds per item. Explain each choice before reopening its rationale; repeat scores reflect familiarity. |
| 6 | Dec 7–10 | Timed practice + error log | If you already have a legitimate 160-question practice exam, use Monday for a 3-hour timed run. Otherwise, use a 3-hour review block: 34 minutes for this set, 60 minutes explaining the answers, and 86 minutes repairing your error log. The 30-question repeat is not a full-length simulation. Spend the next two days only on missed areas. Light review the day before. |
| Test | Fri, Dec 11 | If this is your first or second TMC attempt and a retake is needed, the two-business-day reapplication example is Tuesday, Dec 15. A further attempt still requires NBRC eligibility, acceptance before the applicable cutoff, and an appointment by Dec 31; it is not guaranteed. |
Three-week plan (starting late — test by December 31)
| Week | Focus |
|---|---|
| 1 | Confirm eligibility and apply in time for the earlier published cutoff, Dec 15; then book an available appointment. Baseline: the 30 questions, with NBRC’s free practice examination as an optional format check. Then blood gases, ventilator management (IIIC, IIIE), and calculations — a focused block of applied skills; adjust it to your recorded errors. |
| 2 | Devices (IIA), airway care (IIIA), Patient Data assessment and procedures (IB, IC, ID). Redo the relevant questions above, explain each distractor, and work through the cited examples for your missed topics. |
| 3 | Use the timed-practice/review block described in Week 6 above, then only your misses. Test by your confirmed appointment date. |
The six-week dates are an editorial planning example, not an NBRC requirement. If you start later, use the shorter plan without compressing application, accommodation, or retake rules. For first-time NBRC accommodations, submit the required request before applying and paying; see the Candidate Handbook, p. 3.
Should you still take the TMC?
The TMC is in its last window: the last day to test is December 31, 2026, and NBRC stops taking TMC applications in mid-December. If you're eligible and prepared to sit by December 31, the TMC is still an option — but when you test matters more than it usually would.
| Application planning date | Last TMC test day | New RT Examination starts |
|---|---|---|
| Tue, Dec 15, 2026 — earlier published cutoff; confirm with NBRC | Thu, Dec 31, 2026 | Mon, Jan 4, 2027 |
NBRC currently lists two different application cutoffs: its RT Examination page says December 15, and its Resources FAQ says December 17. Plan around December 15 unless NBRC confirms the later date to you.
| Your situation | What to do |
|---|---|
| Ready, or close, and you want a second chance if it goes badly | Apply and aim to sit by Friday, December 11, if this would be your first or second TMC attempt. NBRC lets you reapply online two business days after an attempt. Testing December 11 puts that example reapplication on Tuesday, December 15 — the earlier published cutoff. After the third attempt, a minimum 120-day wait applies between subsequent attempts. Any retake also requires eligibility, application acceptance and an available appointment by December 31; late-December seats aren't guaranteed. |
| You'll need until the second half of December | You can still test through December 31 if your application is accepted in time — but plan on one attempt. A further TMC attempt may not fit the remaining application and appointment window; otherwise, the RT Examination is the next exam route if you meet its admission requirements. |
| You pass at the high cut but don't finish the CSE this year | NBRC keeps the CSE open through December 31, 2027 for eligible people who pass the TMC at the high cut “prior to December 31, 2026.” Alternatively, eligible candidates can take the new RT Examination and pass at its high cut. If your only possible TMC date is December 31 itself, ask NBRC whether a pass that day counts before relying on the CSE route. |
| You pass at the low cut only (CRT) | You hold the CRT. If you still hold only the TMC low cut when TMC testing ends, the route to RRT is the new RT Examination at its high cut, subject to its admission requirements. Scoring below the low cut on that exam does not take away a CRT you already hold. |
| You don't pass the TMC by December 31 | Use the RT Examination route, available from January 4, 2027, if you meet its admission requirements. Your TMC attempts do not count toward the RT exam's three-attempts-then-wait rule. |
| You're applying under a CRT-to-Registry route | That admission provision ends December 31, 2026 and will not qualify you for the new RT Examination. Confirm that you meet the new exam's admission requirements. NBRC's published transition text does not clearly resolve whether a CRT-to-Registry candidate who hits the high cut in 2026 can still sit the CSE in 2027 — get NBRC's answer in writing before relying on that route: info@nbrc.org, 913.895.4900. |
Sources: NBRC's RT Examination, TMC, and CSE FAQs, its RT Examination page, and the Candidate Handbook, p. 13 (reapplication timing and attempt waits).
Fees, for comparison: TMC $190 first attempt / $150 repeat. CSE $200. RT Examination $360 new / $300 repeat. If you're headed for the RRT, the first-attempt two-exam route is $190 + $200 = $390, compared with $360 for the new single exam — a $30 difference. Price alone isn't a reason to rush — your readiness and the retake window are. Source: Candidate Handbook, p. 8, Examination Fees.
Apply: through the NBRC Practitioner Portal. An online application receives an immediate response: either a request for more eligibility information or a prompt to schedule. If you need NBRC accommodations for the first time, submit the request before applying and paying. Then book the appointment with PSI. NBRC testing is normally Monday through Saturday; the handbook lists November 26–27 and December 24–25 among the 2026 holiday closures in this study window, and notes that additional PSI closures may apply. Source: Candidate Handbook, pp. 3 and 8.
Exam-day basics
From the NBRC Candidate Handbook (revised September 3, 2026, pp. 11–14) and NBRC's results FAQ:
- The testing software has an on-screen calculator; personal calculators aren't allowed.
- Scratch paper is handed out one sheet at a time and must be returned.
- Arriving more than 15 minutes late counts as a no-show: no test, no refund.
- You see pass/fail on screen when you finish; the score report is emailed within 24 hours. It goes to the address on file with PSI; contact PSI if it has not arrived within 24 hours.
Common questions
Will my earlier TMC study materials still work?
For TMC topic coverage, compare it with the 2020 TMC outline, which remains in force through December 31, 2026. Outline alignment alone does not verify an older resource's clinical recommendations; check those against current guidance. For the 2027 RT Examination, use NBRC's RT outline: its 160 scored items comprise 100 Breadth of Knowledge items and 60 Depth of Clinical Judgment items.
Is the new RT Examination harder?
NBRC's stated aim is to keep the standards of the CRT and RRT credentials while moving to one exam. The new examination has not started, so operational pass-rate data are not yet available. The free NBRC RT practice examination provides an official preview of the content and question types. Source: NBRC RT Examination FAQs.
Does passing get me a license?
No. NBRC awards the credential; the responsible state agency issues any required license. Follow that agency's application and practice requirements. NBRC's Candidate Handbook, p. 7, NBRC and State Licensure directs licensure questions to the responsible state agency.
Sources
Last verified October 29, 2026 — NBRC dates, fees, exam format, the TMC content outline, and the teaching sources cited beside the questions. The conflicting application-cutoff dates and individual transition-eligibility limits are described above.
- NBRC Resources — Examination, TMC, and RT Examination FAQs
- NBRC Candidate Handbook (rev. 09/03/2026)
- NBRC TMC Detailed Content Outline (effective January 2020–December 31, 2026)
- NBRC RT Detailed Content Outline (effective January 2027)
- NBRC TMC examination page
- NBRC Free Practice Examinations
- NBRC RT Examination page
- Clinical references for each practice question are linked in its rationale.
About this page. Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the National Board for Respiratory Care (NBRC). Exam and credential names identify their subjects; trademarks belong to their respective owners. The practice questions are original and are not NBRC exam items. Written by the Castleport Test Prep Editorial Team. AI assistance was used in developing and editing these educational scenarios. We checked NBRC's exam facts against NBRC's own pages and handbook, and each practice answer against the guideline or reference linked beside it; that is source checking, not clinical review. These exercises are for exam study, not patient-specific care instructions. See our methodology and editorial standards.