NBRC TMC Exam Overview

The TMC Exam and Why It Matters

The National Board for Respiratory Care (NBRC) administers the Therapist Multiple-Choice (TMC) examination, the gateway credentialing test for respiratory therapists in the United States. The TMC is unusual among certification exams because a single sitting can produce two different outcomes from two different cut scores: a lower score earns the Certified Respiratory Therapist (CRT) credential, while a higher score earns the CRT and makes you eligible to sit the Clinical Simulation Examination (CSE) on the path to the Registered Respiratory Therapist (RRT) credential.

Exam Details at a Glance

Two Cut Scores, One Exam

The most distinctive feature of the TMC is its dual cut score design. The same 140 scored items are evaluated against two thresholds:

• Low cut score (86): earns the CRT credential. You pass, you are certified, but you may NOT proceed to the CSE.
• High cut score (92): earns the CRT and RRT eligibility. You may then schedule and sit the CSE.

A candidate scoring 86-91 is in a frustrating middle zone: certified as a CRT but locked out of the RRT pathway until they retake the TMC and clear 92. Because most employers prefer or require the RRT, savvy candidates target the high cut score from the start. Treat 92 as your real goal, not 86.

The two cut scores are determined through standard-setting (a modified Angoff method) and are reported on a raw scored-item basis. NBRC publishes the high cut score because it doubles as a quality benchmark for CoARC-accredited programs: programs track the percentage of graduates who reach the high cut score within three years as one of their threshold outcome metrics. For you as a candidate, the practical lesson is that the high cut is intentionally demanding — it certifies advanced competency — so do not assume that 'passing' means 86. If your goal is employment competitiveness, you are studying to clear 92.

Scored vs. Pretest Items

Of the 160 items, 140 are scored and 20 are unscored pretest items that NBRC is field-testing for future forms. You cannot tell which is which, so answer every question as though it counts. There is no penalty for guessing on the TMC, so never leave an item blank — a blank is a guaranteed zero, while even a random guess gives you a 25% chance.

The Clinical Simulation Exam (CSE)

Candidates who reach the high cut score must then pass the CSE:

Each CSE problem opens with a scenario and asks you to gather data (order tests, perform assessments) and make decisions (select interventions). Selecting irrelevant or harmful options costs points, so the CSE rewards focused, evidence-based clinical reasoning rather than ordering everything available.

Testing Logistics and Remote Proctoring

PSI delivers the TMC at physical test centers or via remote proctoring from home. Remote candidates need a webcam, microphone, stable internet, and a private, clutter-free room; a government-issued photo ID is required and a proctor scans your space. Same content, same timing, same security — but technical failures during a remote session can end the attempt, so a test center is the safer choice if your connection is unreliable.

A few logistics worth knowing before you book. You apply and pay through the NBRC portal, NBRC issues an authorization, and then you schedule the seat with PSI; the authorization window is time-limited, so do not let it lapse. On test day you arrive early, store all belongings, and receive an on-screen tutorial that does not count against your three hours. The interface lets you flag items and revisit them, and an on-screen calculator is provided for the math-based questions (oxygenation indices, FiO2, dead-space ratios). No personal notes, phones, or reference cards are permitted in the room.

Results post to your NBRC account, typically within two to three business days, as a pass/fail outcome plus a content-area performance breakdown that is invaluable for planning a retake if needed.

Who Should Take This Exam

The TMC is the single national credentialing exam most U.S. states require for respiratory therapist licensure, so nearly every new respiratory therapy graduate sits it. Confirm your specific state board's requirement, because a handful of states accept the CRT for licensure while many employers still insist on the RRT for hiring or advancement. Aligning your target score with both your state rule and your career plan prevents an unnecessary second attempt.