Disclaimer:

Medicine and respiratory therapy are continuously changing

practices. The author and publisher have reviewed all information
in this report with resources believed to be reliable and accurate
and have made every effort to provide information that is up to
date with the best practices at the time of publication. Despite our
best efforts we cannot disregard the possibility of human error
and continual changes in best practices the author, publisher, and
any other party involved in the production of this work can
warrant that the information contained herein is complete or fully
accurate. The author, publisher, and all other parties involved in
this work disclaim all responsibility from any errors contained
within this work and from the results from the use of this
information. Readers are encouraged to check all information in
this book with institutional guidelines, other sources, and up to
date information. Respiratory Therapy Zone is not affiliated with
the NBRC, AARC, or any other group at the time of this
publication.

More tips and tricks can be found by clicking here. J

©Respiratory Therapy Zone 2019 and beyond.

2
Introduction

Are you taking the TMC Exam soon? If so, and if you’re like me, you
are probably a nervous wreck. I know I sure was. You’ve just spent
months taking all your classes and cramming loads of information
into your brain, and now it’s show time. Time to put it all on the
line.

Well I have good news for you. If you practice and prepare like you
should, you will be just fine. It’s that simple. It’s not about how
many total hours you put in. It’s how many of the right hours you
put in. That means in order to make the exam much easier on
yourself, you need to be studying the right things. And I’m here to
help you do just that.

It wasn’t too long ago that I was in your shoes, frantically trying to
learn all the information that they require us to know. But I want
this exam to be easier for you than it was for me. That is why I
created this little cheat sheet. It isn’t meant to serve as a study
guide that covers all the information you need to memorize. Not
hardly. But it is loaded with some solid actionable tips and tricks
that I learned from my experience taking the exam.

And the good news is, you can use them as well to get a leg up on
the NBRC. I’ll tell you all about my experience taking the exam,
which will give you a good sample of some of the things that you
are almost guaranteed to see when you take it as well.

Some or most of the information found in this book you may

already know. If so, that’s a great news! Because it means you are
already ahead of the game. Still, you should go through this guide
and use to information to refresh your memory on what’s to come.

Either way, these tips are simple to read and quick to learn, and
you can easily apply them when you take the TMC Exam yourself.
So are you ready? If so, let’s go ahead and dive right in!

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1. The NBRC usually includes a question about how to identify an
ET tube on a chest radiograph.

The distal tip of the tube should be seen in the middle of the
trachea. An ET tube that is too deep will be in the right mainstem
bronchi. They love to ask questions about this on the exam.

There is always at least one question regarding knowing the

proper placement of an ET tube. Do this by: palpation of the larynx
and neck, check for bilateral breath sounds, look for moisture
condensation of the inside of the tube, detect exhaled CO2, look
for symmetric chest expansion on exhalation, check the tip of the
tube placement on chest x-ray, observe that the 24 cm mark of
the tube is at the patient’s teeth.

2. Expect to see at least one question about MIP or maximum

inspiratory pressure. It’s a quick and noninvasive procedure for
measuring inspiratory muscle strength.

The NBRC likes to ask questions about it in regards to mechanical

ventilation. Basically, be sure to remember that in order to wean
the patient from mechanical ventilation, they need to have an MIP
of at least -20 cmH2O.

3.You will definitely see a question about the placement of the

CVP stop-clock or arterial pressure transducer.

Just remember that it should be placed at the mid-chest for

accurate pressure measurements. If it’s placed above the mid-
chest, the measurement will be falsely low. If it’s placed below the
mid-chest, the measurement will be falsely high.

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4. General tip to remember: A decreased cardiac output is
caused by hypovolemia or heart failure. Cardiac output may also
be decreased on a ventilator dependent with high peak pressures
or a high PEEP.

They may ask you a question in regards to a patient with a

decreased cardiac output. So in that case, you should know to
“decrease the PEEP.”

5. There is always a question about this on the exam and it

always causes mass confusion with students, but since you’re
reading this cheat-sheet, you will get it correct.

Remember, with a nebulizer system, if there is water condensate

inside the aerosol tubing, the inspired oxygen percentage will
increase. This is because the backpressure on the jet and air
entrainment ports prevents room air from being drawn into the
system.

6. Rules of thumb for Bronchodilators:

• A fast-onset medication (example: albuterol) is used to treat a

patient with acute bronchospasm.
• A long-duration medication (example: salmeterol) is used to
treat a patient with chronic, stable bronchospasm.
• A vasoconstriction medication (example: racemic
epinephrine) is used to treat airway edema or bleeding.

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7. There is always a question about when it’s appropriate for a
Respiratory Therapist to stop a bronchodilator treatment.

Basically, you need to know that if the patient’s heart rate

increases by more than 20% from the baseline pre-treatment
heart rate, then you should stop the treatment immediately and
notify the physician.

8. Pro tip: Don’t worry about memorizing the doses for all the
different specific drugs in your study guides. It’s too much. In
general, the NBRC typically doesn’t ask for specific drug doses.
They really just want you to know what the drug treats.

However, it may be a good idea to remember that a standard

albuterol SVN dose is 0.5 mL (2.5 mg), three to four times a day. If
any, this would be the one dose that you could possibly see on the
exam.

9. There will definitely be 1 - 2 questions about adjusting IPPB on

a patient for the desired outcome.

Intermittent Positive Pressure Breathing (IPPB) is used to expand

the lungs, deliver aerosol medications, and in some circumstances
ventilate the patient.

For example, you should know:

• Increase the pressure in order to give a larger tidal volume.
• Decrease the pressure to give a smaller tidal volume.
• If the patient needs a faster breath, increase the flow.

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10. There will be multiple questions about selecting or changing
to the appropriate ventilator mode.

General rules of thumb:

• Select A/C if the patient needs full breathing support.
• Use SIMV if the patient need partial support.
• Use PS to overcome the resistance of the ET tube.
• If the plateau pressure is greater than 30 cmH2O, change
from volume-cycled to pressure-cycled.

11. It is crucial to know how to find a patient’s Ideal Body Weight

on this exam, given the patient’s height. That’s because you will
use their IBW to determine their initial tidal volume setting on the
ventilator. You can use this easy formula to calculate IBW:

IBW = 50 kg + (2 x the number of inches over 5 ft.)

So if they give you a question where the patient is 5’5”, you can
plug the numbers in the formula, quick and easy:

IBW = 50 kg + (2 X 5)
IBW = 60 kg

There will be several questions where you will need to determine

the initial tidal volume of a patient to set them up on a mechanical
ventilator. You will need the IBW in order to do so.

Use an initial tidal volume of 5 - 10 mL/kg of ideal body weight.

So using the patient above with an IBW of 60 kg, their initial tidal
volume should be set between: 300 – 600 mL

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You get that by multiplying the IBW of 60 kg by 5 – 10 mL/kg.

60 X 5 = 300 mL
60 X 10 = 600 mL

Tidal volume = 300 – 600 mL

Bonus Tip: (Just because there’s so many more I want to share

with you!)

There will be a few questions regarding the respiratory rate of a

patient of a ventilator.

You may get ABG results where the patient has a high CO2 level. In
this case, you know the patient is hypoventilating or not
ventilating properly, so you will need to increase the respiratory
rate in order to blow off some of that CO2.

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Conclusion

So there you have it, the eleven 12 tips and tricks you can use to
immediately get a leg up on your competition. In this case, it is
You vs. the NBRC. Apply what you learned in this cheat sheet and
you’ll have a nice head start and be on your way to passing the
exam on your first attempt.

I hope this information is helpful for you. If so, then I have good
news. This is only a small sample of some of the tips, tricks, and
insights that I learned while taking (and passing) the exam myself.

I got these tips straight from our course, Hacking the TMC Exam.

In the course, I share 157 more tips and tricks just like the ones
here in this cheat sheet. You can definitely use them to help pass
the TMC Exam on your very next attempt, like many other
students have done.

Click Here to check it out!

Thank you so much for downloading and reading this cheat sheet.
I know you’re going to do incredibly well when you take TMC

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Exam yourself. Keep working and studying hard. You’re almost to
the finish line and all of the hard work you’re doing now will soon
pay off in a big way.

I wish you the best of luck on your journey and as always, breathe
easy my friend.

10
TMC Practice Questions

Bonus time! As a bonus with this cheat sheet, I want to share a few
practice questions with you as well. The more studying and
practice the better, am I right? You can go through these free
practice questions as another way to help prepare for the TMC
Exam. Below you’ll find the questions, correct answer, and detailed
rationale explaining why each answer is the correct answer. So are
you ready?

1. While inspecting an elderly female patient, you note that she

has an abnormal anterposterior (AP) curvature of the spine.
This best describes which of the following?
A. kyphosis
B. scoliosis
C. kyphoscoliosis
D. pectus excavatum

An abnormal AP curvature of the spine is called kyphosis. Other

common deformities are 1) pectus carinatum (abnormal anterior
protrusion of the sternum); 2) pectus excavatum (depression of
part or all of the sternum); 3) scoliosis (abnormal lateral curvature
of the spinal); and 4) kyphoscoliosis (a combination of kyphosis
and scoliosis which may produce a severe restrictive lung defect).

The correct answer is: kyphosis

2. While auscultating a patient’s chest, you hear intermittent

“bubbling” sounds at the lung bases. Which of the following
best describes this finding?
A. “bronchial sounds heard at lung bases”
B. “wheezes heard at lung bases”

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 C. “rhonchi heard at lung bases”
D. “crackles (rales) heard at lung bases”

The preferred term for short, discontinuous adventitious lung

sounds that are crackling or bubbling in nature is crackles. Many
clinicians still use the term rales for these sounds. Crackles are
caused either by movement of excessive secretions in the airways
(course crackles), or by collapsed airways opening during
inspiration (fine crackles).

The correct answer is: “crackles (rales) heard at lung bases”

3. While feeling a patient’s radial pulse, you note that the pulse
feels bounding and full. Which of the following conditions
would likely be the cause of this finding?
A. hypovolemia
B. hypertension
C. cardiovascular shock
D. low cardiac output

A ‘bounding’ pulse is characterized by forceful pulsations that

quickly disappear, indicating a high systolic pressure without a rise
in diastolic pressure (increased pulse pressure). A bounding pulse
is normal during exercise or as a result of a ‘fight or flight’ release
of epinephrine. A bounding pulse also can signal an abnormal
condition, most commonly hypertension due to atherosclerosis or
disorders causing increased stroke volume. Hypovolemia, shock,
and low cardiac output usually result in decreased systolic and
pulse pressures.

The correct answer is: hypertension

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4. A patient is cachexic, exhibits generalized edema and dry skin,
and appears to be lacking energy. The most likely problem in
this scenario is:
A. heart failure
B. Addison’s disease
C. renal failure
D. malnutrition

A weak or emaciated appearance (cachexia); generalized edema

(anasarca); cracked lips (cheilosis); dry, scaly skin; and listlessness
are all physical signs associated with severe malnutrition

The correct answer is: malnutrition

5. Before giving an aerosol treatment, you see a note in the chart

that states your patient had pink frothy secretions on
admission to the emergency department. This is most likely
indicates which of the following:
A. cor pulmonale
B. left ventricular failure
C. an electrolyte imbalance
D. ARDS

Frothy pink-tinged secretions are a hallmark sign of cardiogenic

pulmonary edema, which is the result of left ventricular failure or
CHF.

The correct answer is: left ventricular failure

6. After feeling chest pain and shortness of breath, a 38-year-old

female drove herself to the emergency room. After starting
oxygen therapy on the patient, the RRT performed a physical
exam and noted: a hyperresonant percussion note on the right

13
 side and a tracheal shift to the left. What is most likely the
cause of these findings?
A. broken ribs on the right side
B. right-sided pneumothorax
C. broken clavicle on the right side
D. acute myocardial infarction

The patient’s signs and symptoms best fit those of a right-sided

pneumothorax. Although it is possible for a patient to have a
broken bone, this would not produce shortness of breath, a
hyperresonant percussion note on the right side, and a tracheal
shift to the left side. An acute MI could cause sudden chest pain
and shortness of breath, but would not cause a hyperresonant
percussion note or tracheal shift.

The correct answer is: right-sided pneumothorax

7. You have a patient who walks slower than people of the same
age because of breathlessness. How would you characterize
their degree of dyspnea?
A. slight
B. moderate
C. severe
D. very severe

You can assess a patient’s exercise tolerance via interview using

the American Thoracic Society Breathlessness Scale. By inquiring
as to when breathlessness is first noticed by the patient, you can
assign a rating to the symptom, with a descriptive term for each
level. In this case, a patient who walks slower than people of the
same age on level ground because of breathlessness or has to
stop for breath when walking at own pace on level ground would
be characterized as having moderate dyspnea.

The correct answer is: moderate

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8. After assessing an acutely dyspneic and hypotensive patient,
you note the following, all on the left side of the chest: reduced
chest expansion, hyperresonance to percussion, absent of
breath sounds and tactile fremitus, and a tracheal shift to the
right. These findings most likely suggest:
A. left-sided pneumothorax
B. left-sided consolidation
C. left lobar obstruction/atelectasis
D. left-sided pleural effusion

An acutely ill patient with dyspnea, hypotension, unilateral

findings of reduced chest expansion, a hyperresonant percussion
note, absent of breath sounds and tactile fremitus, and a tracheal
shift to the right has most likely suffered a large pneumothorax on
the affected side. If the pneumothorax is severe enough to disrupt
cardiac function, blood pressure will also fall.

The correct answer is: left-sided pneumothorax

9. While assessing a patient, you notice that her responses to

your questions are unclear. Which of the following would be
your most appropriate response?
A. “Please go on”
B. “You seem to be anxious”
C. “I see why you are so upset”
D. “Please explain that to me again”

When a patient’s response to a question is initially vague, one

should seek clarification from the patient. Examples of clarification
methods include questions such as “I don’t understand what you
have just said - please explain that to me again”.

The correct answer is: “Please explain that to me again”

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10. You’ve asked your patient to inhale as deeply as possible and
blow out all of the air as hard as they can until empty. Which
test is being performed?
A. FVC
B. IC
C. TLC
D. MVV

When a patient performs a maximal exhalation after a maximal

inhalation, he is performing the forced vital capacity (FVC)
maneuver.

The correct answer is: FVC

These detailed questions come directly from our book of practice

questions, the TMC Test Bank. It contains over 1000 practice
questions, just like these, in the exact format like the ones on the
TMC Exam. Going through practice questions is an excellent way
to prepare for your board exam and test your knowledge.

Click Here to check it out!

16
About the TMC Exam

The TMC Exam has a total of 160 questions. 140 of them are actual
questions that will be graded while the other 20 questions are just
experimental questions for future exams. It is impossible to tell
which questions are which, so you much try equally as hard on
each and every question.

The exam is broken into two threshold scores, the low-cut and
high-cut. If you pass with the low-cut score, you will be rewarded
the CRT credential. If you pass with the high-cut score, you will be
rewarded the CRT credential, and you will also now be eligible to
sit for the Clinical Simulation Exam. Then, if you pass the Clinical
Simulation Exam, you will be rewarded your RRT credential.

TMC Exam Rules

The test is fully computer-based and you will have three hours to
take the exam. Do not spend too much time on difficult questions
that you do not know the answer right away. It’s best to just skip
them because you can always come back to them later. In your
final analysis, though, it is better to guess or at least pick
something than to leave the question unanswered.

You will not be able to bring a calculator to use for the exam. A
pencil and a sheet of scratch paper will be provided for you. No
outside notes or books are allowed. You must return your scratch
paper after completing the exam.

No personal belongings are allowed in the testing area. You will

need to leave them in your car.

You may leave the testing area at any time to stretch or use the
restroom. Keep in mind, though, that your test timer will not stop.

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Be on time. If you arrive more than fifteen minutes late, you will
not be admitted to take the exam.

You will need to show two forms of identification, with at least one
showing a current photograph. Both forms must be current and
must include a signature. Forms that are accepted include:
• Driver’s license
• State I.D. card
• Valid passport
• Military I.D. card

Choose the best answer

The TMC Exam is composed of multiple choice questions with four

possible answers: A, B, C, and D. So you must select the BEST of
the four answers. That’s right, unfortunately there may potentially
be two answers that could be interpreted as correct. According to
the evil NBRC, it’s expected that you will be able to select the best
answer of the two. Most of the questions, however, will distinctly
have one answer that is clearly the correct choice.

Preparing for the Exam

Plan your study time wisely. You should begin studying months in
advance preferably, but at the least, weeks before the exam. Set
up a schedule if you have to. Just make sure you keep track of how
much time you have left before you take the exam and don’t let
time slip away.

Practice with real-life exam questions

We touched on this earlier, but using practice questions is an

excellent strategy to help you learn and understand all the
information that is required of you for the exam. Going through
practice questions again and again definitely helped me pass the
exam on my first attempt.

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Again, be sure to check out our TMC Test Bank which has over
1000 questions exactly like the ones you will see on the exam.

Pace yourself during the exam

You need to make sure you have enough time to get through all
the questions. I struggled with this because I almost ran out of
time when I took the exam. I had to go through and guess on
about 8 questions that I had skipped as the last few seconds
ticked away on the timer. Fortunately, I had answered enough
questions correctly already to pass with the high-cut score. That is
why I want to stress this to you so you can do a better job than I
did.

You should shoot for about 55 questions per hour. This should give
enough time to answer every question and look over those you
aren’t sure about. The computer software will allow you to
“bookmark” any questions that you want to skip and revisit.

Use your scratch paper wisely

This strategy is crucial. Before you start your exam, you will have
the opportunity to write out anything you want onto the scratch
paper they provide you. You will definitely want to take advantage
of this. For instance, I made a drawing of the ‘lung box’ on my
scratch paper and was able to use it all throughout the test to
answers questions about PFTs. Also, there were a list of several
normal values for mechanical ventilation weaning that I wrote out
to refer to during the exam.

Just figure out the information that would be useful to YOU. This
will be different for everyone. Look it over one last time before you
enter the testing center and make sure you have it memorized.
Then before you begin your test, write it out on your scratch paper
to refer to through the whole exam. This tip is crucial.

Read each question carefully

19
It’s natural for us to want to skim the question and rush to select
an answer, especially when our brain is tired. You must focus and
completely read each question AND answer carefully. You will be
able to eliminate at least two choices most of the time.

Interpret only the important data

The NBRC at times will try to throw you off by including

information that is irrelevant to the question. Make sure to
disregard the unimportant information that does not pertain to
the question being asked.

Answer every question

Again, I just want to remind you to answer every question before

you submit the exam. It’s okay to skip a question you aren’t sure of
and come back to it. But before you hit submit, make sure you at
least make a guess because it won’t count against you.

Memorize and know the Normal Values!

It’s very important that you know and memorize all the normal
values and ranges for the exam. We cover these in depth in our
TMC Study Guide. It’s crucial that you know and memorize all of
the important normal values for the exam.

Prepare your body and mind

This means you should get a good night’s rest and eat a good
dinner. Don’t overdo it with the caffeine. Stick with your normal
dose. For me, that’s usually one cup of coffee. Trust me, you will
have plenty of adrenaline running through your body as you get
ready to begin. Also, avoid sleeping pills, because you definitely
don’t want to oversleep or wake up feeling groggy.

Focus on the most heavily tested subjects

20
This is why we created our online course, Hacking the TMC Exam.
To help you do just that. The tips and tricks in the course can help
you pinpoint exactly what information you are likely to see on the
exam and what you should be focusing your time one the most.

Also, it’s important to have an idea of how many questions from

each subject will be on the exam. Review this chart for an estimate
of the number of questions for each subject:

Subject Number of % of Exam

Questions
Patient Assessment 12 9
Infection Control 4 3
Arterial Blood Gases 10 7
PFTs 6 4
Advanced Cardiopulmonary 4 3
Monitoring
Oxygen and Medical Gas 10 7
Therapy
Hyperinflation Therapy 2 1
Humidity and Aerosol Therapy 8 6
Pharmacology 10 7
Airway Clearance Therapy 3 2
Cardiac Monitoring and 5 4
Cardiopulmonary Resuscitation
Airway Management 10 7
Suctioning 4 3
IPPB 3 2
Mechanical Ventilation 38 27
Home Care and Pulmonary 4 3
Rehab
Special Procedures 5 4
Cardiopulmonary Pathology 2 1
Total 140 100

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And last but not least… Do not Cram!!!

Don’t try to cram all the information into your brain a few days
before the exam. Especially don’t cram the night before.
Unfortunately, if you do not know the information by now, then
these final few hours really aren’t going to make that big of a
difference. This test requires more time to truly learn and
understand all of the information. Again, shoot for at least two
months.

Thank you again for downloading this cheat sheet! I truly hope
that this information can help put you on the right track towards
preparing for and passing the TMC Exam.

As I said before, I want to make life easier for each and every
Respiratory Therapy Student in the world. Period. That’s my #1
goal. I’m striving for Respiratory Therapy Zone to serve as the
resource I never had as a student.

This is why I’ve spent thousands of hours of my own time creating

tons of content and study materials that I wish I had as a student.
The good news is — it’s all available for you now so that you don’t
have to go at it alone like I did.

Use all the information in this eBook and you’ll crush it when you
take the TMC Exam. Keep working hard and studying harder, and
as always, breathe easy my friend. I wish you the best of luck! J

©Respiratory Therapy Zone 2019 and beyond.

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