HealthcareSeptember 25, 20267 min read

NBRC TMC Exam Content Outline 2026: Domains, Weights, Traps

Every NBRC TMC domain, how much of the paper it is, what its questions ask you to do and the order to study it in, straight from the NBRC outline.

  • 3Domains
  • 160Questions
  • 180 minTime
  • 50%Heaviest area
  • $190Exam fee
NBRC TMC exam content outline 2026 with domain weights

Table of Contents

The outline at a glance

National Board for Respiratory Care publishes the Therapist Multiple-Choice (TMC) Examination outline that every NBRC TMC question is written against (TMC Detailed Content Outline effective January 2020 - December 31, 2026 (last TMC test day)). This page turns that document into what you actually need before you study: how big each area is, what the questions in it ask you to do, and the order to learn it in.

Heads up: the TMC ends on December 31, 2026NBRC's last TMC test day is December 31, 2026 (applications close December 15). From January 1, 2027 one Respiratory Therapy Examination replaces both the TMC and the CSE: 185 items (160 scored) in 4 hours, $360 for new candidates. Its low cut score awards the CRT and its high cut score awards the RRT, so the two-cut-score idea survives, the second exam does not.
3domains
  • III. Initiation and Modification of Interventions~70 questions50%
  • I. Patient Data~50 questions35.7%
  • II. Troubleshooting and Quality Control of Devices, and Infection Control~20 questions14.3%
One exam, two cut scores: the low cut awards the CRT; the high cut awards CRT plus eligibility for the Clinical Simulation Examination (RRT). The outline also lists patient conditions items may be linked to (e.g. COPD, asthma, ARDS, heart failure, trauma, neonatal RDS, sepsis, lung cancer). Starting January 1, 2027 the TMC is replaced by the Respiratory Therapy Examination (outline published Oct 2025): 160 scored items in a 100-item Breadth of Knowledge portion (Patient Data 25, Management of Devices and Patient Safety 25, Interventions 50) and a 60-item Depth of Clinical Judgment portion, delivered as linear-on-the-fly forms.

What each domain actually asks

The official outline describes what each area covers. Below is what the questions in it ask you to do, which is what decides how you should study it.

III. Initiation and Modification of Interventions

50%~70 items

It asks you to: The heaviest domain asks what you would do next: which ventilator setting to change after an ABG, when to recommend extubation, which drug or dose change fits the patient, or how guidelines like ARDSNet, NAEPP or GOLD apply. 30 of its 70 items are at the analysis level.

  • A. Maintain a patent airway incl. artificial airway care (10 items)
  • B. Airway clearance and lung expansion (5 items)
  • C. Support oxygenation and ventilation (15 items)
  • D. Administer medications and specialty gases (4 items)
  • E. Ensure modifications are made to the respiratory care plan (18 items)
  • F. Utilize evidence-based practice (6 items)
  • G. High-risk situations (5) / H. Assist a physician or provider with procedures (4)
  • I. Conduct patient and family education (3 items)

I. Patient Data

35.7%~50 items

It asks you to: Questions hand you a chart finding, ABG, PFT, chest film description or bedside measurement and ask what it means, what to measure next, or which diagnostic test to recommend (e.g. calculate a P/F ratio and classify it, or spot auto-PEEP from a pressure reading).

  • A. Evaluate data in the patient record (10 items)
  • B. Perform clinical assessment (10 items)
  • C. Perform procedures to gather clinical information (12 items)
  • D. Evaluate procedure results (10 items)
  • E. Recommend diagnostic procedures (8 items)
  • ABGs/CO-oximetry, PFTs, chest imaging, hemodynamics, ventilator mechanics and sleep studies

II. Troubleshooting and Quality Control of Devices, and Infection Control

14.3%~20 items

It asks you to: Items describe a device behaving wrongly (low-pressure alarm, no flow from a flowmeter, a bubbling chest drain, out-of-range QC) and ask for the most likely cause or the correct fix, or which equipment to select for a given patient.

  • A. Assemble/troubleshoot devices (15 items)
  • B. Ensure infection prevention (2 items)
  • C. Perform quality control procedures (3 items)
  • Oxygen delivery, cylinders, regulators and concentrators
  • Ventilators, CPAP/NPPV, humidifiers, nebulizers and inhalers
  • Artificial airways, suction, pleural drainage and blood gas analyzers
Cognitive level. 140 scored items: 33 recall (23.6%), 66 application (47.1%), 41 analysis (29.3%). By domain: Patient Data 15/27/8; Devices & Infection Control 8/9/3; Interventions 10/30/30 (recall/application/analysis).

Study it in this order

Weight is the only honest guide to where your hours go. The areas that make up the first half of the paper are core; the next third is support; whatever is left is a quick win you review last, not skip.

DomainWeightItemsPriority
III. Initiation and Modification of Interventions50%~70Core
I. Patient Data35.7%~50Support
II. Troubleshooting and Quality Control of Devices, and Infection Control14.3%~20Quick win

Item counts are the weight applied to 140 scored questions and rounded, so treat them as approximate.

How the exam is built

ItemDetail
Questions160
Scored questions140
Unscored pretest items20
Time180 minutes
Question typesMultiple-choice (single best answer)
DeliveryComputer-based at PSI assessment centers (NBRC: 'Monday through Saturday at more than 300 assessment centers across the country'); on-screen calculator provided; no remote-proctored option described in the NBRC Candidate Handbook
Passing standardRaw score (one point per correct scored item) compared with two cut scores set by a subject-matter-expert standard-setting study: achieving the low cut score earns the CRT; achieving the high cut score earns the CRT and eligibility for the CSE. No penalty for guessing. NBRC does not publish the numeric cut scores on its exam pages.
Fee$190 — TMC $190 new applicants / $150 repeat applicants. The replacement RT Examination (from Jan 1, 2027) costs $360 new / $300 repeat. TMC applications close Dec 15, 2026; last test day Dec 31, 2026.
RetakesThree attempts without waiting; then a minimum of 120 days between each subsequent attempt. Reapply online two business days after the exam.
Published pass rate78.5% (TMC new (first-time) candidates at the low cut score (CRT level), exams given Jan 1 - Dec 31, 2025. Same group at the high cut: 68.2%. Repeat candidates: 48.9% low / 29.4% high. Low-cut new-candidate rate was 78.9% in 2023 and 79.5% in 2024., 2025)

Where candidates lose marks

These are the places the outline and the real exam part ways, the parts of the outline candidates misjudge most often:

  1. Under-weighting Domain III: Initiation and Modification of Interventions is 70 of 140 scored items (50%), and 30 of those 70 are analysis-level, so memorizing facts alone won't get you through.
  2. Aiming only for the low cut: the same sitting decides CRT vs CSE eligibility, and first-time pass rates drop from 78.5% (low cut) to 68.2% (high cut), so target the high cut from the start.
  3. Skipping equipment troubleshooting: Domain II is 20 items (15 on assembling/troubleshooting devices) and is often under-studied compared with ABGs and ventilators.
  4. Running out of time: 160 items in 180 minutes is about 67 seconds per item, and the 20 pretest items are unmarked, so every item has to be answered.
  5. Studying the wrong outline: TMC ends Dec 31, 2026. Anyone testing in 2027 sits the RT Examination with a new outline (Breadth of Knowledge + Depth of Clinical Judgment), a 4-hour limit and a $360 fee.

Turn the outline into practice

ExamCert AI has 500 CRT practice questions with explanations, built around the same outline this page walks through. Work them by domain, find the weak area, and fix it before test day.

Practise CRT on ExamCert AICRT vs RRT 2026

FAQ

What is on the TMC exam?

The TMC has 140 scored items across three domains: Patient Data (50 items), Troubleshooting and Quality Control of Devices and Infection Control (20), and Initiation and Modification of Interventions (70). By level, 33 items are recall, 66 application and 41 analysis.

How many questions are on the TMC and how long is it?

There are 160 multiple-choice items (140 scored plus 20 unmarked pretest items) with a three-hour limit. An on-screen calculator is provided and there is no penalty for guessing.

What score do I need to pass the TMC for the CRT?

NBRC uses two cut scores on one raw score (one point per correct scored item): the low cut earns the CRT and the high cut also makes you eligible for the CSE. NBRC does not list the numeric cut values on its exam pages; your score report shows how you did against them.

Is the TMC outline changing?

Yes. The current outline is valid until the TMC's last test day, December 31, 2026. From January 1, 2027 candidates take the Respiratory Therapy Examination, whose outline (published October 2025) has a 100-item Breadth of Knowledge portion and a 60-item Depth of Clinical Judgment portion.

Sources

Figures on this page come from NBRC and the other primary sources below:

Checked September 25, 2026. Fees, outlines and eligibility rules change — confirm with NBRC before you book.