Preparing for the Therapist Multiple-Choice (TMC) Exam

  • Three Months before the Exam

Review the appropriate NBRC exam matrix at least three months before your scheduled exam and highlight the tasks (terms and procedures) that are not familiar to you. One of the most common mistakes is to review everything or review tasks that you know very well.

Make sure you understand the unfamiliar terms or tasks that you have identified in the exam matrix. For each term or task you should learn: what it is, how it is done, why it is done, what are the indications, contraindications and problems associated with the item. As you find and collect the information from different sources (e.g., textbooks, lab and clinical manuals, review tests), organize the information on a note card for later reviews.

For each study day, prepare note cards for several (say 5) unfamiliar items or tasks that you have identified on the exam matrix. After several weeks, you should have a collection of useful new materials for your review sessions. You may use these note cards for study on a regular basis.

Read and study the note cards in a way that helps you to understand the information. Understanding is the key because most of the exam questions are constructed at the “application” and “analysis” levels. Do not try to remember everything (see exceptions below).

Items that you need to memorize: (A) conversion factors and calculations; (B) normal values and ranges, (C) associated terms, and (D) common protocols. Examples include:

(A) conversion factors for different size oxygen cylinders, helium/oxygen gas therapy and flow rate; (B) normal values and ranges for hemodynamic, electrolytes, ECG arrhythmias, and important radiographic and laboratory findings; (C) Associate terms such as “infants, viral bronchiolitis, respiratory syncytial virus (RSV), Virazole (ribavirin), and SPAG II nebulizer, clogging of respiratory tubings and valves;” (D) Common protocols such as initial ventilator settings, ACLS algorithms.

Use mnemonic techniques to memorize lists, definitions, and other specific kinds of information. For example, the mnemonic for the algorithm for ventricular fibrillation and pulseless ventricular tachycardia could be “SCREAM” which stands for “Shock, CPR, Rhythm, Epinephrine, Antiarrhythmic Medications.”

There are many free self-assessment exams (e.g., or Take these exams, identify your areas of deficiency, and determine how you can improve on the test results. Ask your instructor about the exams and areas of deficiencies. Six to eight weeks before the NBRC exam, set aside study sessions into manageable time segments in which you will not be interrupted by others at home or at school. You will likely to learn and retain more if you study for short periods of time (one hour) and over a longer period of time (several weeks) than if you cram the information in a few days. Cramming will only make you nervous during the exam since you are unsure if you have adequately covered all areas of deficiency.

  • Days before the Exam

Candidates should get an email reminder of the exam from the Customer Service of Applied Measurment Professionals (a subsidiary of NBRC).

On the days before the exam, arrange transportation or prepare the car to make the trip safely, gather and set aside your admission email, two photo identifications (driver’s license or passport and another form of identification with your name and signature), car keys, eye glasses, directions to the testing center, and other items that you would need (e.g., prescription medications). You will not be able to bring into the testing center your cell phone, calculator,  pencil, pen, paper, or water bottle.

You should keep your normal daily routine, avoid alcohol and unusual foods and get a good night’s sleep. Set the alarm clock and leave home early to allow extra time for traffic and weather conditions. Dress in layers so that you will be comfortable no matter what the temperature might be at the testing center. Since most testing centers are also a place for business (e.g., tax services), call ahead and check for availability of disposable ear plugs. Bring your own if necessary.

  • Day of Exam

Arrive at the testing center at least 30 minutes before your appointment time. You will be asked to show two different forms of identification – one with your picture on it. You will be asked to read and initial several statements. You will also be asked to sign the form to acknowledge the type and length of the exam, no reference sources allowed, etc. You must also print your name on a light colored scratch paper for use during the exam. You must turn off the cell phone and pager or leave it in your car. Disqualification may result if the cell phone or pager goes off during the test. In some testing centers, your possessions (e.g., cell phone, pager, car keys, calculator, pen, billfold, purse) may be placed in a bag which is locked and hung on your seat. The only items provided to you are a pencil and the colored scratch paper. The paper and pencil must be turned in to the proctor after the exam.

Before the test, you may want to clarify with the proctor on use of water fountain or restroom during the test. Since the camera is actively aiming at you during the entire test, you do not want to disappear from your seat without the proctor’s knowledge.

  • Right before the Exam

After you are seated, you will log in and have your picture taken. You will be required to finger print your right index finger 4 times. You will be given online practice questions that are not related to respiratory care. The practice allows candidates to get used to the exam (i.e., using the mouse and keyboard, selecting answers). You should use majority of this time to do an “information dump” by writing down normal values, formulas and certain key information on the sheet of blank paper provided to you. This information will come in handy as a quick reference source during the exam.

If you choose to write down some key information before the test, set aside one section of the sheet of paper for “information dump.”

  • During the Exam

Multiple-choice questions involve a statement or question and you are asked to complete the statement or provide the answer to the question. The primarily strategy is to make the best, most reasonable connection between the statement and your answer. Some helpful tips are described below.

  1. Your attitude is crucial. Be confident. Remind yourself that your goal is not to make a perfect score (even experts cannot achieve a perfect score each time). Aim for achieving 90% correct answers. A common mistake is to aim for the passing score (e.g., 70%). On national credentialing exams, it is common to run across questions that you know nothing or very little about. Since credentialing exam items were developed, reviewed and revised by many different individuals, the final version can become ambiguous. Take each question seriously not matter if they are “easy” or “difficult.” If you are not careful, you may “over think” a simple question. On the other hand, you may miss one or more important details in a more complicated question.
  2. Look for the main point and key words in the questions. For well constructed questions, they should contain all of the information needed for the correct answer. You must read the question and all answers thoroughly and carefully.
  3. For questions involving calculations, the unit in the answer tells you how to solve the math problem. For example, if the unit in the answer is “L/cm H2O,” it tells you to use the volume (L) divided by the pressure (cm H2O).
  4. Anticipate the answer before looking at the answers. This process will increase your concentration and exercise your memory. This process also helps to put yourself “in the zone.”
  5. Each of the four answers deserves equal consideration. Evaluate all answers even if you have your own answer in mind. Other answers may prompt you to look for other key words in the questions. If an answer says “erroneous data,” you should review the data again because this could be the correct answer.
  6. Unusual words are typically inserted in the question to make the correct answer stands out. Therefore, those unusual words make useful clues. For example, in “… the reservoir bag completely deflates near end of inspiration…” the unusual words “completely deflates” is used to emphasize the lack of flow to the bag. In fact, the correct answer reads “The helium/oxygen flow to the reservoir bag is too low.”
  7. Answer all questions in order and avoid jumping and skipping around. Do not spend too much time on one question because each question is worth one point. If a question is confusing or too difficult, take a guess (but make a note on the sheet of paper provided to you for later review) and move on to the next question. You can return to these questions if you have sufficient time at the end of the exam.

Since you may run out of time, you should not leave any blanks during the test. Take the best guess and write down the question number for further review if time permits. If you choose to take this approach, use another corner of the sheet of paper provided for this purpose.

  1. Multiple true-false answers call for selection of correct options and elimination of incorrect options. This systemic approach helps to reduce confusion when each answer contains two or more options. Another style of true-false answers looks like a box with columns and rows. For example:

A mechanically ventilated adult patient in the ICU has developed ARDS, the clincal signs and symptoms may include: (B = correct choice)

Lung compliance P/F ratio Plateau pressure
A Increased Decreased Decreased
B Decreased Decreased Increased
C Increased Increased Decreased
D Decreased Increased Increased
  1. If you do not know an answer, eliminate highly plausible answers and make an educated guess. On questions with four answers, if you can eliminate one answer, your chance of guessing correctly increases from 25% to 33%. If you can eliminate two choices, it increases to 50%. On the TMC exam, you are not penalized for guessing. Choose an answer for every question. Do not leave any questions unanswered. You are disadvantaged by leaving questions unanswered when time is running out.
  2. If you have to guess, eliminate distracters and mark an answer. Note the question numbers on the sheet of paper provided so you may review them later if time permits. Consider the following if you need to guess: (A) If two choices are similar (e.g., “increase in compliance” and “decrease in elastance,” eliminate both answers because the question cannot have two correct answers; (B) If two choices are opposites (e.g., “hypertension” and “bradycardia”), choose one or eliminate both (opposite answers may both be used as distracters); (C) The most general alternative is usually the correct answer; (D) Answers that are totally unfamiliar to you are often used as incorrect distracters.
  1. Identify key words that set a priority. Key words such as “initially, immediately, best, most” call for a ranking of importance among the answers. The ranking must be based on the condition described in the question stem. For example, checking the pulse is the most important step before defibrillation attempts and it may not be the most important step before an aerosol therapy.
  1. Remember that you are looking for one best answer for the question. Other incorrect answers may be partially correct, but not the best answer for that question. Furthermore, the best answer for the question does not have to be true all of the time, in all cases and without exception. Do not second guess yourself and use “what if” to assume certain conditions in order to “justify” your choice. Choose the best answer based on all of the information provided in the question, no more and no less.
  1. Since most NBRC exam items are constructed at the higher cognitive levels (application and analysis), ask yourself: (A) what is the main problem that you are being asked? (B) what are the key words that point to the problem? (C) does your answer provide a solution to the problem stated in the question?
  1. The rule of thumb to budget time wisely is to allot one minute for each question. Keep track of your time every 30 minutes to ensure that you will be on pace to complete the entire exam. If you run out of time and leave 10 questions unanswered, you will have missed 10 points. For the 160-item (three-hour) TMC exam, you should complete 30 questions in 30 minutes in order to have ample time to finish the exam in the allotted time.

(CAUTION: Most self-assessment examinations have LESS number of questions (140 instead of 160) but allow the same allotted times (3 hours or 180 minutes). You should pace yourself at one minute per question, regardless of the amount of time allotted for the self-assessment exam. Again, one minute per question is a good rule of thumb).

  • End of the Exam

  1. Use all of the time allotted for the exam. Resist the urge to leave early.
  2. Review the questions that you have marked on the sheet of paper for further review.
  3. Change answers only if you are certain that you have made errors (i.e., marked the wrong answer, misread the question, uncovered new information previously not clear to you).
  • After the Exam

You will be required to complete a survey about the test scheduling process. After completing the survey, you will receive the test results from the proctor before leaving the testing center.

  • Congratulations on your success! Be proud of your achievements.

Should you miss the passing score, do not feel despair. Try to refine your study skills and habits. Re-take the exam when you are ready.

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