How to Prepare for (and Pass) the Clinical Simulations Exam (CSE)
by John Landry, BS, RRT | Updated: Jan 11, 2024
If you’re reading this right now then it most likely means that you’ve already passed the TMC Exam. If so, congratulations! That is an amazing accomplishment and it means that you’re one step closer to becoming a Registered Respiratory Therapist.
I just want to say thank you for coming to Respiratory Therapy Zone as a way to help prepare for the Clinical Simulations Exam. Our #1 goal is to help you pass the exam on your very first attempt. And the details that are listed out for you below in this article can set you on the right path to do just that.
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We’re striving to provide you with the most current information needed to prepare for the CSE and will give you all the information that you will be expected to know for the exam by the NBRC.
So if you’re ready, let’s go ahead and dive right in!
How to pass the Clinical Sims Exam?
First and foremost, in order to pass the Clinical Simulations Exam, it’s going to take a lot of hard work and dedication from you. There’s no way around it. This is a mindset that you must adopt early on in the preparation process.
Once you set your mind to the fact that you CAN pass the exam through hard work and dedication, it makes everything else a whole lot easier.
Clinical Simulations Exam Rules
There will be a total of 22 problems on the exam that are selected from 8 different categories. Two of the problems are pretested scenarios that are individually scored based on the judgment of the NBRC committee.
Keep These Rules in Mind 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.
- 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.
What are the admission requirements for the Clinical Simulations Exam?
Be aware of the 3-year time limit.
You must pass the Clinical Simulations Exam within three years after graduating for a CoARC accredited Respiratory Therapy Program.
If you do not pass it within this time limit, you will be required to retake (and pass) the TMC Exam again at the high-cut score to regain eligibility.
Outside of the three-year time frame, any previous passing performance to earn the RRT credential is nullified — so please be aware of this.
How much does it cost to take the Clinical Simulations Exam?
The exam costs $200 for both new and repeat applicants. I realize that this is a significant investment, which is why it is our goal to help you pass the exam on your next attempt.
This is another reason why it’s so critical to use a reliable study guide that can truly prepare you for the exam. Otherwise, there’s a good chance that you’ll have to retake the exam, which means you’ll have to pay that exam fee again.
We see this far too often with students.
The good news it, if you put in the work by studying and preparing well, you can pass the exam on your first (or next) attempt, and you’ll only have to pay the fee once.
What content will be on the CSE?
As we’ve already discussed, the same content that was on the TMC Exam will be on the CSE as well. They just ask it to you in a totally different way.
A big focus of the CSE will be on Pathology . You absolutely must how to differentiate and treat the different diseases and what to recommend for these specific patients on a case by case basis.
That is the major focus of the CSE — like it or not.
The NBRC put out a detailed content outline of exactly what to look for on the CSE. I highly recommend that you take a look over it and you can do so by visiting this link .
How are the problems structured on the CSE?
Here’s an example of how the problems will be structured on the computer screen:.
As you can see, 3 windows will appear on the screen at all times during the exam.
1) There is a window with the “Scenario” at top of the screen, and your picture will be displayed in the upper right-hand corner of this window.
Each simulation begins with a brief paragraph in this window that provides preliminary information about the patient. The following sections will contain information about the changing patient situation in this window as well.
Each Scenario Window will also provide you with specific instructions about whether to “CHOOSE ONLY ONE” response in the section or to “SELECT AS MANY” responses as appropriate to gather information.
It is super-important that you follow these directions!
2) The “Options” window is displayed in the lower left portion of the screen. This window contains all options, choices, or possible responses that you can choose from.
You select an option by clicking the check box next to the option.
3) The “Simulation History” window is displayed as the lower right portion of the screen. This window shows the options chosen in the current section and the results for each choice are displayed in this window.
It also shows the “Simulation History” from all previous sections as well as the options chosen.
Basically, it helps you see the results that you selected already, in case you forgot.
When you are finished with a particular section, you can hit the “Go To Next Section” button at the bottom left of the screen to continue to the next section.
A box will pop up requesting that you confirm your wish to continue to the next section. Be sure to only click the “Yes” button when you are 100% ready to proceed to the next section, because you can’t go back.
A timer button is shown in the lower right portion of the screen and displays the time remaining for the exam. You may hide the time remaining button if you wish, simply by clicking it.
Two of the problems are pretested scenarios that are individually scored based on the judgment of the NBRC committee. The total points scored on these will be added to your results at the end.
Each version of the exam will be different which means that each version will have a minimum passing score. Of course, this is decided by the testing committee for each exam. Exam Hint: More than half of the total possible points will come from the selections you make in the Information Gathering sections.
That is why it’s a major focus throughout this study guide. If your final score exceeds the minimum passing score, that means you will have passed the exam.
On average, you will need to score roughly a 72% in order to pass the CSE.
- It is necessary for proper care and not doing it would cause harm to the patient.
- You can earn (+2) points for selecting very important information for good patient care.
- You can get (+1) for information that is helpful.
- You get 0 points for the selections you make that are neither helpful nor harmful to the patient.
- You lose a point (–1) for selecting something that is counterproductive.
- You lose two points (–2) for making a selection that is very counterproductive.
- This includes any selection that could result in harming the patient, or worse.
What are the Components of a Clinical Simulation Problem?
- Scenario – This establishes the setting and general parameters of the patient and (you) the Respiratory Therapist.
- Information Gathering – This section provides information about the patient that is normally obtained in chart review or diagnostic testing, such as vital signs , ABG results, etc.
- Decision Making – This is the decision point that you will need to recommend what happens next for the patient.
How to Prepare for the CSE? We’ve already touched on this earlier, but now, let’s dive a little bit deeper. In order to increase your chances of passing the exam, you need to be prepared for the unique exam structure. As we said, the CSE covers much of the same topical content as the TMC Exam, they just ask it in a totally different way. You have to take what you know and apply it to a real-life situation in order to make a decision to help the patient — just as if it were in a real hospital. What Diseases will be on the CSE?
Now let’s talk about all the different diseases that you must know for the exam.
As you now know, Cardiopulmonary Pathology is super-important in regard to the Clinical Simulations Exam! It’s what you should spend most of your time on when preparing for the exam.
Here are the 8 disease categories that you should focus on when preparing for the CSE:
What is the structure of the cse.
Again, we already talked about this some earlier. But now, let’s dive deeper into the Scenario , Information Gathering , and Decision Making .
They will list out 15-20 parameters for you to choose from.
For example, you will see vital signs, ABG , PFT, and various lab studies.
You must select ONLY those that are important for this patient at this particular time given what you know.
Avoid selecting anything that could be dangerous for the patient. Also, of course, avoid selecting anything that you know is unnecessary for the patient at this time.
Select only the desired information!
Once you click an option to make a selection, it will reveal that results of what you clicked on the screen.
For example, if you select that the patient needs an ABG , as soon as you click that option, it’s going to show you the patient’s ABG results on the screen.
Exam Hack: This is important, so remember this. During the Information Gathering, if you can already tell that the situation is a medical emergency, you should act right then to help the patient.
If it’s not an emergency, you can proceed to gather more information.
For example, general appearance, appearance of the chest, respiratory rate, respiratory pattern , posture, sensorium, and color.
For example, pulse, temperature, chest percussion, breath sounds, blood pressure, heart sounds, tracheal position, and capnometry, etc.
Basic Lab Tests
Examples include lab tests like blood culture, PFTs , imaging studies like MRIs, CT scans, bronchoscopy, ICP, hemodynamic monitoring, and specific tests like sweat chloride test for CF, Apgar score, V/Q scan, etc.
These tests are very specific for specific patient situations.
Exam Hack: There are a few options that you should Always select when they are available. These are quick to obtain and usually always helpful in identifying the patient’s problem.
Here are some examples: Color/general appearance, respiratory rate, heart rate, SpO2, blood pressure (if the problem deals with the heart), body temp (only if an infection is involved), level of consciousness, breath sounds, and history of present illness.
For example, you probably don’t need the check any PFT results for a patient with ARDS .
This is where you must take what you know from the information given and make the best possible decision for the patient.
Usually, you will be asked to select the best of 4–5 options.
Keep in mind, sometimes you will have to make the Best Available selection if the most desired option is not listed.
Just because it says this does not necessarily mean you are wrong. Proceed to pick the next best option using the information that you have available. After you’ve made your decision, you will be taken to the next scenario. You must then evaluate how the patient responded to the decisions you previously made.
This pattern between Information Gathering and Decision Making usually cycles back and forth about 4–5 times for each problem.
You take what they give you, gather the necessary information, then make the best decision possible for the patient.
Boom, easy peasy!
So there you have it! That wraps up this guide on how to prepare for (and pass) the clinical simulations exam. I truly hope that this information was helpful for you.
This wasn’t meant to teach you everything you need to know in order to pass the CSE. We couldn’t possibly fit everything into one article.
However, this information will definitely set you on the right path to learning exactly what you need to know so that you can earn your RRT credential . Thank you so much for reading all the way to the end. I wish you the best of luck and as always, breathe easy my friend.
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
- “The National Board of Respiratory Care,” www.nbrc.org/examinations/rrt . Accessed 24 June 2020.
- “The National Board of Respiratory Care,” www.nbrc.org/examinations/rrt/#clinical-simulation . Accessed 24 June 2020.
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How to Pass the NBRC RRT Clinical Simulation Exam (CSE)
The NBRC clinical simulation exam has the distinction of being the hardest exam to pass of all allied health fields. This includes nursing, radiology, physical therapy and laboratory technician board exams. With a current pass rate of only 62% for first time candidates it’s no wonder you’ve ended up on this blog post, searching for ways to improve your chances of passing. Repeat CSE exam candidates faired even worse with just a 47% pass rate in 2021.
Here’s a list of things to do and not do while challenging the toughest test the NBRC has to offer; the dreaded Clinical Simulation Exam , or CSE.
When gathering information, do not choose a test or assessment you’ve never heard of.
Do not order time consuming tests during an emergency., do things in the correct order, do not use the patient’s weight given in the exam question to select a tidal volume..
Review the NBRC CSE detailed content outline
Learn and practice at the same time.
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Midterm 1 Review
Reviewing for Midterm 1
Sample midterm created by course coordinator: http://web.cse.ohio-state.edu/software/2221/web-sw1/readings/SampleExam.pdf
Study guide created by me: CSE 2221 Midterm 1 Review.pdf
Provided on the CSE 2221 homepage is an example midterm . Please read through this and note a few things:
- The types of questions on the exam. There are multiple choice, tracing tables, short answer, writing code, and tree drawing/comprehension. Notice that on this sample, theres even a question about CheckStyle's "magic numbers". Be ready to face any of these on the midterm.
- The wording of the exam questions. The questions you get on your midterm will have questions that are created similar to this. They give you some necessary background and then pose a question. For instance, 1.4 tells you what Random1L's "nextDouble()" instance function does, then asks you to do something with it.
- The number of questions on the exam. It isn't short and sweet. Time yourself on this practice exam to see how you're doing time-wise. Think about optimizing your time usage to get the most points possible. Is it really worth arguing in your head over if a multiple choice question is (a) or (b), or is it wiser to start writing a response for a question worth 3-5 times as many points? Which leads me to...
- The point values. Though the midterm won't have exactly the same point values per question, they will be similar. There are a number of multiple choice, each only worth a few points. Tracing tables, writing code, and short response are all worth much more. Know which questions will get you the most points.
- Extra credit. I can't guarantee that there will be extra credit on the midterm, but it is likely. If you can snag some free points from a problem that is more difficult, that's great! But don't kick yourself in the bum if you can't solve it. Those points don't count against you, but the other questions you miss will.
In addition to the example midterm, there is also a study guide of sorts I've made, available here . You'll find over 100 questions that are much different than the practice midterm and tend to focus on the basics and concepts. I provide answers to all of the questions in the second half of the document. DISCLAIMER: These are not written like the sample midterm (and your actual midterm) are written! My questions are very short and are to the point. Questions you get on the midterm have a different structure. Don't only use my study guide for studying, use both mine and the sample midterm!
Q: Do I need to memorize functions for XMLTree, SimpleWriter, etc.?
A: For the most part, no. You do not need to remember everything that the XMLTree class can do and the specific function calls. When we think you need to know a function call, we will tell you on the test. For example, we don't expect you to memorize how to make a new Random1L and create a double in [0, 1). We tell you how to do that, and then ask you to do something with that information. That said, we do expect you to know things like how to read a line of input, or output a line with in.readLine() and out.println(). You shouldn't need to look at the OSU components API for anything on the exam.
Q: What is covered on the exam?
A: Everything we've covered so far. Java/JVM, variables, mathematical models for those variables, control flow, loops, static methods, parameter passing, arrays, design by contract, trees, XML documents, CheckStyle/FindBugs, HTML, anything we've done in projects and anything we've done in lab. If you've seen it in class/lab/homework/projects, its fair game!
Q: How long is the exam?
A: 55 minutes, one class period. You will probably need the entire class period. Come with a pencil and eraser.
Q: Where is the exam?
A: In the lecture room for the class, as defined on your section page on the CSE 2221 home page .
Good luck and have fun! Go Bucks.
Registered Respiratory Therapist (RRT)
The RRT credential is nationally recognized as the “standard of excellence” for respiratory care professionals.
The examinations for the RRT credential objectively and uniformly measure essential knowledge, skills and abilities required of advanced respiratory therapists. The NBRC evaluates the competency of respiratory therapists and ensures that graduates of accredited respiratory care education programs have every opportunity to earn the RRT credential. It is in high demand nationwide, and we work diligently to help to fill the shortage of qualified respiratory therapists in the field.
The first examination for earning the RRT is the Therapist Multiple-Choice (TMC) Examination (prior to January 2015, it was known as the Written Registry Examination). The TMC Examination evaluates the abilities required of respiratory therapists at entry into practice and determines eligibility for the Clinical Simulation Examination (CSE). The CRT and/or RRT credentials are used as the basis for the licensure in all 49 states that regulate the practice of respiratory care.
For more information, click or tap on a topic below, or visit our CSE FAQs .
The CSE consists of 22 problems (20 scored items and 2 pretest items). The clinical setting and patient situation for each problem are designed to simulate reality and be relevant to the clinical practice of respiratory care. You will be given four hours to complete the CSE.
For specific exam content, refer to the Detailed Content Outlines.
CSE Detailed Content Outline – effective 1-2020
Please ensure you meet the following requirements before applying for the CSE Examination:
1. Be a CRT and have successfully completed the Therapist Written Examination (WRRT) or the Therapist Multiple-Choice Examination (TMC) at the high cut score. and 2. Be a graduate of and have a minimum of an associate degree from a respiratory therapy education program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC). or 3. Be a CRT for at least four years prior to applying for the examinations associated with the RRT credential. In addition, the applicant shall have at least 62 semester hours of college credit from a college or university accredited by its regional association or its equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics. or 4. Be a CRT for at least two years prior to applying for the examinations associated with the RRT credential. In addition, the applicant shall have earned a minimum of an associate degree from an accredited entry-level respiratory care education program. or 5. Be a CRT for at least two years prior to applying for the examinations associated with the RRT credential. In addition, the applicant shall have earned a baccalaureate degree in an area other than respiratory care and shall have at least 62 semester hours of college credit from a college or university accredited by its regional association or equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics. or 6. Hold the Canadian Society of Respiratory Therapists (CSRT) RRT credential.
Free Practice Exam
A free CSE practice examination is available so you may familiarize yourself with the content and types of questions that will be included on the credentialing exam.
ATTENTION – By accessing this examination, you agree not to reproduce, distribute, disclose, offer for sale, or sell any portion of these copyrighted National Board for Respiratory Care, Inc. materials in any format. Failure to comply with these terms may result in disciplinary action by the National Board for Respiratory Care, Inc. including loss of your credential, losing your ability to retake an examination, and/or legal action related to copyright infringement.
Anyone planning to take the Clinical Simulation Examination can assess how they will perform before actually attempting the examination by taking the official NBRC Self-Assessment Exam (SAE). The feedback from the SAE provides an opportunity to evaluate and remedy less-than-desirable examination performance before taking the credentialing examination. The official SAEs are the only products that provide the respective examination committees’ rationale for the best response to each question. There are two forms of the Clinical Simulation Self-Assessment Examination available.
Official SAEs are only available in web-based format for purchase online through the NBRC’s testing agency, PSI. PSI’s e-store offers all currently available NBRC web-based SAEs for purchase online.
To take an online SAE, you must have:
• A compatible internet browser such as the current version of Internet Explorer, Chrome, Firefox or Safari. Other browsers may not work. • Cookies and scripting must be enabled. • Pop-up blocking must be disabled.
After your order is placed, you will receive a confirmation e-mail with specific instructions guiding you through the examination process. The e-mail contains your private password that allows you to receive individualized feedback on your performance. You will have 90 days from the time you receive your confirmation e-mail to complete the examination.
Please note: If you purchase an NBRC SAE, your credit card statement will reflect a purchase from LXR .
General Exam Info: Tools for Candidates
These additional tools are available at no cost to help you prepare for the examination:
- Candidate Handbook : Information, applications and other forms for all NBRC credentialing examinations
- Log in with your email address – this is the email address where your results will be sent.
- Use the mouse to select your responses and to proceed through the examination.
- To obtain your results, you must take the entire examination in one sitting. Your results will not be saved if you exit the examination.
- When you have completed the examination, click Finish and Display. Your results will be displayed on screen and emailed to the address you provided at login.
- If you need assistance using the examination software, click on the Help button in the lower portion of the screen once you begin the examination.
- To take the online practice exams, you will need a compatible internet browser such as the current version of Internet Explorer, Chrome, Firefox, or Safari. Other browsers may or may not work. Cookies and scripting must be enabled and pop-up blocking must be disabled.
- Assessment Centers : A listing of assessment centers where exams are offered nationwide, searchable by state or zip code
- General FAQs : Information on credentials, fees, credential maintenance and other NBRC information.
- Credential Maintenance Program (CMP) Brochure : Detailed information on the NBRC’s Credential Maintenance Program
- Submit an Online Application
- Printable CSE Application
What are the admission requirements for the Clinical Simulation Examination?
Please ensure you meet the following requirements before applying for the Clinical Simulation Examination:
1. Be a CRT and have successfully completed the Therapist Written Examination (WRRT) on or before December 31, 2014; OR Be a CRT and have successfully completed the TMC Examination by achieving the high cut score on or after January 2015.
2. Be a graduate of and have a minimum of an associate degree from a respiratory therapy education program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC).
3. Be a CRT for at least four years and have at least 62 semester hours of college credit from a college or university accredited by its regional association or its equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics.
4. Be a CRT for at least two years and have earned a minimum of an associate degree from a respiratory therapy education program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC).
5. Be a CRT for at least two years and have earned a baccalaureate degree in an area other than respiratory care and shall have at least 62 semester hours of college credit from a college or university accredited by its regional association or equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics.
6. Hold the Canadian Society of Respiratory Therapists (CSRT) RRT credential.
What is the application process, and how long does it take?
You may apply online or submit a paper application and fee once you have met the admission requirements.
If applying and paying by credit card online, your application is processed immediately. If mailing your application and fee, your application will be processed within approximately five to seven business days. An email confirmation notice of eligibility will be sent to you, which includes a website and toll-free telephone number for you to contact to schedule an examination appointment.
If your eligibility cannot be confirmed, you will be notified by email of the additional information required to complete your application.
What are the examination fees?
The CSE costs $200 for both new and repeat applicants.
Are any examination fee discounts offered?
Yes, AARC MEMBERS are eligible for a one-time, $40 discount when applying for the first time for the following NBRC examinations:
– CSE – PFT – NPS – SDS – ACCS
You must register for the AARC Member Discount through the AARC website at https://www.aarc.org/aarc-membership/aarc-membership-benefits/nbrc-discount/ . AARC will send an email after registering for the discount containing instructions about accessing the NBRC’s online examination application. You must begin the application process from the link in the instructions you receive from the AARC by email. The discount must be used at the time you submit your application and payment and will not be retroactively applied.
When is the application deadline?
There are no application deadlines. If you meet the admissions requirements for an examination you may submit your application and fee at any time.
What if I don’t receive an email confirming my eligibility?
If you don’t receive an email confirmation of eligibility or an incomplete notice within two weeks of mailing your application, contact the NBRC . If your application is not on file, you will be asked to send a replacement application form and fee.
When and where are NBRC examinations administered?
NBRC examinations are administered Monday through Saturday at more than 300 assessment centers across the country (except on nationally recognized holidays). Search for an assessment center near you .
Can I schedule my examination online?
Yes. If you are approved to take an examination and paid the appropriate fee, you may schedule online .
Is a free practice examination available?
CSE practice examination
Is a Self-Assessment Examination available?
If you are assessing your preparedness for the Clinical Simulation Examination and feel you need more guidance than the free practice exam, there is a Self-Assessment Examination (SAE) available for purchase.
How much testing time is given to complete the Clinical Simulation Examination?
The testing time for the CSE is four hours.
What content will be included on the Clinical Simulation Examination?
To begin your preparation in an informed and organized manner, you should know what to expect from the actual examination in terms of content areas tested. The detailed content outlines present the specific patient care settings and each of the content areas. The outlines can be used to get a general impression of the examination, and with closer inspection, can give you specific study direction. For example, you can determine the relative importance of each content area on the examination by reviewing the number of questions in each section.
When will I receive my test scores?
You will receive information about your score at the test center after completing the examination.
Do I have to wait between attempts of the examination?
As indicated in the table below, candidates may attempt the Therapist Multiple-Choice and Clinical Simulation Examinations three times, after which the candidate will be required to wait a minimum of 120 days between any subsequent attempt. For the specialty credentialing examinations, including Pulmonary Function Technology, Neonatal/Pediatric Specialty, Sleep Disorders Specialty, and Adult Critical Care Specialty Examinations, candidates may attempt the exam two times, after which the candidate will be required to wait at least 180 days before sitting for the exam again.
As the respiratory profession continues to grow and flourish, we feel this is an important and necessary policy to implement in order to ensure caregiver competency and patient safety for years to come.
What is the NBRC’s Record Retention Policy?
When you apply for an examination, your eligibility records are maintained for one year following application regardless of whether or not you schedule an exam. If you don’t actively pursue credentialing, your eligibility records are inactivated after one year. If you are a candidate whose records are inactivated, you must reapply as a new candidate and meet the most current admissions requirements to be eligible for the exam. Please note: if you have passed one of the examinations to earn the RRT Credential (TMC or CSE) and allow your application records to become inactivated, your passing performance will be nullified, so we encourage you to pursue credentialing in a timely manner after applying and receiving a confirmation of eligibility notice.
To support you through the entire process, we are committed to providing appropriate notices to candidates before their application records are inactivated, so we also encourage you to keep your contact information current with the NBRC.
Does passing the TMC Examination at the high cut score automatically mean I’m eligible for the CSE?
No. You must meet the CSE eligibility requirements, regardless of examination score.
I have already passed one portion of the RRT Examination. What do I do now?
If you passed the Therapist Written Examination (WRRT) prior to January 1, 2015, you are eligible for the CSE. If you passed the CSE but not the Therapist Written Examination (WRRT), you must take the TMC exam and pass at the high cut score to earn the RRT credential.
I‘m a CRT and didn’t graduate with an Associates Degree. Can I apply for the CSE?
Yes. You must satisfy one of the following CRT-to-Registry admission requirements:
- Be a CRT for at least four years prior to applying for the examinations associated with the RRT credential. In addition, you must have at least 62 semester hours of college credit from a college or university accredited by its regional association or its equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics.
- Be a CRT for at least two years prior to applying for the examinations associated with the RRT credential. In addition, you must have earned a minimum of an associate degree from an accredited entry-level respiratory care education program; or
- Be a CRT for at least two years prior to applying for the examinations associated with the RRT credential. In addition, you must have earned a baccalaureate degree in an area other than respiratory care and have at least 62 semester hours of college credit from a college or university accredited by its regional association or equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics.
If I am applying under the CRT-to-Registry Provision, how do I know if I’ve taken the required courses?
The NBRC offers a CRT-to-Registry transcript evaluation at no charge. To request a CRT-to-Registry evaluation, submit a copy of your college transcripts with a completed CRT-to-Registry Evaluation Form to our office. Do not submit an application or fee since you are only requesting an evaluation of your education. Please allow approximately three weeks for a response to your request.
Please note that an evaluation request with no transcript information attached may result in a significantly delayed response.
TMC Exam FAQs
What are the admission requirements for the TMC Examination?
Please ensure you meet the following requirements before applying for the TMC Examination:
1. Be 18 years of age or older.
The TMC Examination costs $190 for new applicants and $150 for repeat applicants.
A free TMC practice examination is available so you may familiarize yourself with the content and types of questions that will be included on the credentialing exam.
TMC practice examination
If you are assessing your preparedness for the TMC Examination and feel you need more guidance than the free practice exam, there is a Self-Assessment Examination (SAE) available for purchase. The TMC SAE has the same number of questions as the credentialing examination.
How much testing time is given to complete the TMC Examination?
The testing time for the TMC Examination is three hours.
What content will be included on the TMC Examination?
TMC Detailed Content Outline – effective 1-2020
What do the cut scores mean?
There are two established cut scores for the Therapist Multiple-Choice Examination. If you achieve the low cut score, you will earn the CRT credential. If you achieve the high cut score, you will earn the CRT credential AND become eligible for the Clinical Simulation Examination (provided you meet the eligibility requirements and are eligible to earn the RRT credential). If you do not achieve a minimum of the low cut score, you must reapply for the TMC Examination.
Does passing the TMC Examination at the high cut score automatically mean I’m eligible for the Clinical Simulation Examination (CSE)?
If I currently hold the CRT credential and score below the low cut score on the TMC Examination, will I lose my CRT credential?
No. You can retake the TMC Examination as many times as necessary to regain RRT eligibility or to become eligible for the Clinical Simulation Examination without impacting the status of your current CRT credential.
Can I qualify to take the TMC Examination with foreign education?
Foreign respiratory therapy education does not qualify for admission to the TMC Examination. You must have a minimum of an associate’s degree from an accredited respiratory therapy education program. View a list of accredited education programs .
Purchase a Voucher
If you are an employer or educator who plans to cover the cost of the NBRC credentialing examinations for candidates, an online prepay option is available for your convenience. Simply follow the link below to purchase a prepaid voucher. Once your payment is made, you will receive a voucher code that your student can use as payment when applying for the exam.
The NBRC continually receives inquiries regarding the CRT-to-Registry provision of the admission policies for the examinations associated with the RRT. If you have questions that are not answered below, or if you need further clarification of this admission policy, please contact the NBRC Executive Office.
To qualify for the CRT-to-Registry admission you must be one of the following:
- A CRT for at least four years prior to applying for the examinations associated with the RRT credential. In addition, you must have at least 62 semester hours of college credit from a college or university accredited by its regional association or its equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics; or
- A CRT for at least two years prior to applying for the examinations associated with the RRT credential. In addition, you must have earned a minimum of an associate degree from an accredited entry-level respiratory care education program; or
- A CRT for at least two years prior to applying for the examinations associated with the RRT credential, and have a baccalaureate degree in an area other than respiratory care with at least 62 semester hours of college credit from a college or university accredited by its regional association or equivalent. The 62 semester hours of college credit must include the following courses: anatomy and physiology, chemistry, microbiology, and mathematics.
Click here for a CRT-to-Registry Evaluation Form.
The NBRC Board of Trustees has not established any minimum hour requirement for the basic science courses. A minimum of 62 semester hours of college credit must be completed; within the 62 hours, a minimum of one course must be completed in each of the following areas: anatomy and physiology, chemistry, microbiology, and mathematics.
The reason semester hour requirements were not established for the basic sciences is the lack of uniformity in hours awarded for similar courses by various national colleges and universities. For instance, some colleges combine anatomy and physiology while others offer them separately and some colleges award hours in semesters and others in quarters. Completion of the courses is more important than the hours awarded for the required courses.
The NBRC suggests you complete more than the minimum one course in mathematics and the basic sciences, because the more knowledge accumulated in these areas, the better your chance for success on the RRT exams. Many colleges and universities require laboratories for science courses, but if they don’t, they are not required for the RRT exam.
If you have a valid CRT credential for a minimum of four years, you must submit your official transcripts at the time of application. The science and mathematics courses must appear, by name, on your official transcripts and it must be apparent you completed the courses. If any of the courses do not appear on the transcripts by these names, you must obtain a course description from the college catalog for any course in question and submit each course description to the Admission Committee, in care of the NBRC, for review and final determination.
If you have had a valid CRT for a minimum of two years and have a baccalaureate degree in an area other than in respiratory therapy, you must provide proof of completion of a baccalaureate degree in the form of either official college transcripts or a notarized copy of your baccalaureate degree. Official transcripts verifying completion of the basic sciences and mathematics must also be submitted at the time of application.
A minimum of one course in anatomy and physiology, chemistry, microbiology, and mathematics must appear, by name, on the official transcript. It must be apparent from the transcript that these courses have been completed. If any of the courses do not appear on the transcript by these names, you must obtain a course description from the college catalog. For any course in question, submit course description to the Admission Committee, in care of the NBRC, for final determination.
College Level Examination Program (CLEP)
Courses challenged through the College Level Examination Program (CLEP) will be accepted toward the 62 semester hours and required basic science courses if transferable college credit is awarded by an accredited college or university for each course completed by CLEP. The courses attempted through the CLEP program and the credit awarded must be recorded on an official transcript.
Courses Completed at Foreign Colleges or Universities
Courses taken at a foreign college or university do not satisfy the NBRC’s requirement of 62 semester hours of college credit. Foreign programs are not accredited by their regional association or its equivalent. If you attended a foreign college, you should contact an accredited college to have transfer credit awarded for the training received. The NBRC will accept transfer credit for foreign courses if an accredited United States college or university is willing to award transfer credit. A letter sealed by the Registrar indicating the courses and hours for which transfer credit is awarded may be accepted in lieu of official college transcripts.
Training Completed at Hospital-Based Nursing or Other Health-Related Programs
If you completed courses at a hospital-based nursing or other educational program not accredited by its regional association or its equivalent, the course work will not be accepted unless transfer credit for the courses is awarded from an accredited college or university. A letter sealed by the registrar indicating the courses and hours for which transfer credit is awarded may be accepted.
Course Descriptions for the Required Basic Science and Mathematics Courses
The NBRC Admissions Committee has developed course outlines for the basic science and mathematics courses required under this provision. The course outlines recommend the content areas which should be covered in each of the basic sciences. These course descriptions are intended for those who have not yet completed some or all courses, and who require guidance in course selection. The course outlines can be obtained by writing the Executive Office.
- verify credentials
- credentialed practitioners
10801 Mastin Street, Suite 300 Overland Park, KS 66210
Email: [email protected]
Phone: 913.895.4900 Fax: 913.712.9283
TMC Practice Exam
Prepare for your test with realistic questions.
The National Board for Respiratory Care (NBRC) administers the Therapist Multiple-Choice (TMC) exam to assess the knowledge and skills of advanced respiratory therapists. Passing this exam is the first step to earning a registered respiratory therapist (RRT) credential.
Click “Start Test” above to take a free TMC practice exam!
TMC Exam Eligibility
To be eligible for the TMC exam, you must be at least 18 years old and meet ONE of the following requirements:
- You must have at least an associate degree from an accredited respiratory therapy education program.
- You must have at least four years of CRT experience and at least 62 college credit hours.
- You must have at least two years of CRT experience and at least an associate degree from an accredited respiratory therapy education program.
- You must have at least two years of CRT experience, at least a baccalaureate degree in any area, and at least 62 college credit hours.
- You must hold the CSRT RRT credential.
TMC Exam Outline
The TMC exam contains 160 multiple-choice questions, 20 of which are unscored, and you will be given a time limit of 3 hours. The unscored questions are called “pretest” questions and are used to validate questions for future versions of the exam.
The exam is split into three sections:
- Patient Data
- Troubleshooting and Quality Control of Devices, and Infection Control
- Initiation and Modifications of Interventions
Each question on the exam will be further categorized into one of three levels of complexity:
- Recall (Re): The ability to recall or recognize specific information
- Application (Ap): The ability to comprehend, relate or apply knowledge to new or changing situations
- Analysis (An): The ability to analyze and synthesize information, determine solutions, and/or evaluate the usefulness of a solution
Here is each section of the exam in more detail:
I. Patient Data (50 scored questions)
The questions in this section test your ability to do the following:
- Evaluate Data in the Patient Record (10 questions)
- Perform a Clinical Assessment (10 questions)
- Perform Procedures to Gather Clinical Information (12 questions)
- Evaluate Procedure Results (10 questions)
- Recommend Diagnostic Procedures (8 questions)
II. Troubleshooting and Quality Control of Devices, and Infection Control (20 scored questions)
- Assemble/Troubleshoot Devices (15 questions)
- Ensure Infection Prevention (2 questions)
- Perform Quality Control Procedures (3 questions)
III. Initiation and Modification of Interventions (70 scored questions)
- Maintain a Patent Airway Including the Care of Artificial Airways (10 questions)
- Perform Airway Clearance and Lung Expansion Techniques (5 questions)
- Support Oxygenation and Ventilation (15 questions)
- Administer Medications and Specialty Gases (4 questions)
- Ensure Modifications are Made to the Respiratory Care Plan (18 questions)
- Utilize Evidence-Based Practice (6 questions)
- Provide Respiratory Care in High-Risk Situations (5 questions)
- Assist a Physician/Provider in Performing Procedures (4 questions)
- Conduct Patient and Family Education (3 questions)
Check out Mometrix's CRT & RRT Study Guide
Get practice questions, video tutorials, and detailed study lessons
TMC Exam Registration
To register for the exam, you must submit an application on the NBRC website. This application should include all necessary documentation to support your eligibility as well as the $190 examination fee.
Once your application is approved, you will receive instructions on how to schedule your exam appointment. You may choose to schedule an in-person appointment at a testing center or an online appointment via live remote proctoring (LRP).
Before registering for the remote proctor option, make sure your equipment meets the requirements. LRP requirements include the following:
- A desktop or laptop computer running at least a Windows 7 or Mac OS X operating system
- Google Chrome browser
- A webcam and microphone
- Minimum 466 kb/s bandwidth
- 2 GB RAM and 1 GB free disk space
- A minimum screen resolution of 1368×768
On the day of your exam, you must present one form of valid government-issued photo identification with your signature. The name on your registration must match the name on your identification. For both delivery methods (on-site and remote), you should arrive or be logged in 30 minutes before your testing appointment.
After you have provided your ID, your picture will be taken and your palm will be biometrically scanned for security purposes. You will then be asked to store all personal items in a secure locker.
Once your personal items are stored, you will be led into the testing room and given a short tutorial on the testing system. Once this step is complete, your exam will begin.
On the day of your exam, ensure that your testing area is clear of reference materials, your cell phone, and food or drink containers. You are permitted two pieces of blank paper and a writing utensil for writing notes. You must use the Google Chrome browser and enable cookies. Ensure you can move the webcam around for the proctor so they can view your area. Present your ID and scratch paper for inspection and follow any directions provided.
You can launch the examination up to 30 minutes before your scheduled appointment. You cannot leave the webcam’s view during your exam, use other monitors, or talk to anyone. If the proctor observes questionable behavior, your exam will be canceled.
How the TMC Exam is Scored
For each question you answer correctly, you will receive one point toward your score. The sum of correct responses is called your “raw score.” Your raw score determines your pass or fail status after comparison to the cut score.
If you achieve the low cut score (88), you will be awarded the CRT credential. If you meet the high cut score, which can fluctuate, you will receive the CRT credential and become eligible to take the CSE.
Retaking the TMC Exam
If you failed the exam, you may take it two more times with no waiting period between attempts. After the third attempt, you must wait 120 days before trying again.
Check out Mometrix's CRT & RRT Flashcards
Get complex subjects broken down into easily understandable concepts
How many questions are on the TMC exam?
There are 160 multiple-choice questions on the exam.
How long is the TMC exam?
The time limit for the exam is 3 hours.
How much does the TMC exam cost?
The examination fee is $190.
By Peter Rench
Peter Rench joined Mometrix in 2009 and serves as Vice President of Product Development, responsible for overseeing all new product development and quality improvements. Mr. Rench, a National Merit Scholar, graduated magna cum laude with a Bachelor of Science in Mechanical Engineering and a minor in mathematics from Texas A&M University.
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