PFT TMC Example style question

A patient’s pulmonary function results are:

%of predicted

  • SVC 85
  • FVC 82
  • FEV1 72
  • FEV1/FVC% 61
  • DLCO 18

Which is the patient’s disease?

  1. Pulmonary Fibrosis
  2. Asthma
  3. Emphysema
  4. Myasthenia gravis

The correct answer is 3.  The FEV1 and FEV1/ FVC make it obstructive (FEV1/FVC <75% and FEV1 <80%)  Asthma is also an obstructive disorder but emphysema is the only obstructive disorder that has a decreased DLCO.

What to expect during the therapist multiple choice (TMC)exam

You are given 3 hours to complete`160 questions during the tmc. If you require accommodations you can fill out this form and submit it.

When you check in they will give you a pencil and a small piece of scratch paper. When you get to your computer I suggest writing down anything you are struggling with, from concepts to equations. Writing the information down will allow you to start the exam with out worrying about those items. You can always erase the stuff you wrote down if you need the space later. During the exam you can’t wear a watch or bring a calculator. On the computer there is an optional time remaining button and a calculator. Previously there wasn’t a calculator available, this started January 2020. This is a great change, now you don’t have to worry about your poor math skills or making a mathematical error.

Answering the questions

Of the 160 questions only 140 are scored. The other 20 questions are potential future questions. Since 20 aren’t even scored don’t be discouraged if you don’t know the answer to a question, just move onto the next question. Remain confident and continue the exam. At the end you can go back to questions you skipped and any question you bookmarked. Usually by the end you will know the answer. If you still don’t know the answer don’t panic. Go through and eliminate the answers you know are wrong then guess. By eliminating the answers you know are wrong you have a higher probability of guessing the answer right. Don’t spend too much time or energy on a question. If you aren’t able to eliminate any of the answers just guess and move on.

There might be two possible correct answers, you need to select the answer most correct answer. For example a question might require you to increase ventilation. Things that adjust ventilation are tv and RR. We know the first thing you adjust is tv so that would the answer you would select.

You are allowed to get up and stretch or use the bathroom but your test timer doesn’t stop. I suggest arriving early to make sure you can use the restroom before your test time.

After you complete the exam

When you are done you turn in your scratch paper and get your results. Make sure you get the results that belong to you. When I took my RRT sims I got a sheet that said I failed (by a lot). I was confused I thought I had done well and didn’t know how to improve. I went to my car to see what areas I did bad in I saw that it was actually a nursing exam report. The person before me never bothered to pick up their results.

If you failed don’t worry you can take it again. Use the results to see what areas you need to improve on. Study and take it again. I recommend waiting a month. A month gives you time to regroup and study.

TMC Style Question and Explanation 4

A patient complains that they have trouble breathing when they lay flat, the doctor orders a chest x ray and asks what further testing you would recommend.  

  1.  BNP
  2.  Pulmonary Function Test
  3. Polysomnography 
  4. ABG

This question is seeing if you understand orthopnea. Orthopnea is when you lay flat and have difficulty breathing, it is caused by CHF.  The only test that relates to CHF is a BNP so that is the correct answer.  It is trying to throw you off by offering test that are associated with pulmonary disease, if you didn’t know what orthopnea was you would probably guess one of those options.
As a reminder when you are studying a condition you need to memorize what tests are used to diagnose it, how it is treated and any other names it might be known as. In this example the scenario could be”A doctor thinks his patient might have orthopnea, he has ordered a chest x ray but would like to know what other tests you recommend?”

You want to achieve your RRT but you are overwhelmed, start here.

If you want to achieve your RRT but don’t know where to start, don’t be overwhelmed. Break down the overwhelming goal of pass the RRT into small more manageable steps. A more manageable goal might be to study 10 minutes a day. You can apply SMART goals to passing the RRT. SMART goals are Specific, Measurable, Achievable, Realistic, Time bound. An example could be I am going to learn the alveolar air equation this week, I will be able to do an example, write out the use of the equation and the normal values. It is achievable because I have time to study 4 days this week. I recommend doing weekly goals because things are less volatile in a week than a month.

If you are still feel overwhelmed and would like a personalized plan or coaching services please contact me at RRTResults@gmail.com.

Sometimes the first thing you have to get right is your mind. I love this quote by Henry Ford “Whether you think you can, or you think you can’t – you’re right “. If you think you can’t do something you will come with a million excuses, I don’t have time to study, I have been out of school too long, I am not a good test taker etc. On the other hand if you think you can pass you will come up with a way to make it happen. You will listen to review tapes on your commute, you will study your review cards while you are waiting for your patient that is eating, you get the idea.

Start small, maybe 10 minutes a day. The people studying habits have found that people are more likely to keep going if they start small and keep doing at least a small amount every day. On days that you are busy or not feeling like studying just do 5 minutes a day. Then go back to your normal routine.

Now that you have decided you can and will pass the RRT we can get down to the how start studying. There are three types of questions on the TMC : recall, application and analysis. Recall questions are definition based questions . Application questions will require you to know what equipment or treatments are appropriate in the situation they give you. Analysis questions require to go through the given test results and situation and give the appropriate treatment. I have examples of type of questions. In general the most questions are application, followed by recall and analysis. The specific number of each type of question for each test content area is available on the NBRC website.

In addition to knowing what equipment and treatments are, you need to know how to trouble shoot it and how and when to use them. When you are reviewing equipment and treatments memorize when you use it and what conditions it is associated with. For example, polysomnography is an overnight sleep study used to diagnose sleep apnea. It would be used when a patient complains of snoring, waking up multiple times at night gasping and excessive daytime sleepiness. On the exam they might use different names for things, don’t get frustrated with this, when you are studying memorize all the possible names.

Analysis questions are the least common on the exam but generally give test takers the most problems. For analysis questions you need to know what the normal values are, how to treat the problems and in what order to treat the issues. There is a system to follow with analysis questions as outlined below. Once you get the hang of this system analysis questions will not intimidate you. Studying analysis questions helps you prepare for the exam because it has recall and application components.

You are address issues in the following order

  1. Ventilation
  2. Oxygenation
  3. Perfusion and circulation
  4. Underlying issues

If during your analysis of the situation there is a ventilation issue you address that before moving on to the next area. If there is no ventilation issue after you analyzed the situation you move on to oxygenation and go down the sequence to underlying issues. This might sound confusing you might assess the situation and think that the person has a pneumothorax, while it might be the person’s underlying issue it will affect ventilation so you treat it first.

I know it seems like a lot to do but start studying a few minutes a day, start with one flash card a day that has normal values or equipment. When you are studying think of when you would use the equipment and any other names the equipment. I have 10 free flash cards here to get you started.

Types of questions on CRT/ written RRT exam and how to prepare for them

There are three types of exam questions on the tmc, recall, application and analysis.

Recall are the easiest and are definition based. For example a recall question might be:

What device can provide the most precise fio2?

  1. A nasal cannula
  2. A venturi mask
  3. An oxymask
  4. A non rebreather

An application question might be:

  • You are working in the emergency room and a patient that has a history of COPD comes in for SOB and hypoxia. The doctor wants you to start oxygen at 35%. What device would you use? A nasal cannula
    1. A venturi mask
    2. An oxymask
    3. A non rebreather

An example of anaylsis question could be:

You are working in the emergency room and a patient that has a history of COPD comes in they have the following vital signs HR 119, RR 42, BP 178/86. They are using their accessory muscles to breathe and are lethargic. ABGs are done on the patient while they have a 6lpm simple mask on, the results are pH 7.28, pCO2 78, Bicarb 23, Po2 and 58. The doctor says to use what you want to treat the patient but that he wants to start with a fio2 of 60%. Which would you start on the patient?

  1. An oxymask at 12 lpm
  2. A venturi mask at 60%
  3. Mechanical ventilation with an fio2 of 60%
  4. Non invasive ventilation with 60% fio2

In the above example we first ask is the patient ventilating? Based off their abg result of uncompensated respiratory acidosis they aren’t ventilating so we have to adjust ventilation. There are two choices that address ventilation and can deliver a precise fiO2, bipap and mechanical ventilation. Mechanical ventilation is probably unnecessary for this patient so non invasive ventilation (bipap) with a fio2 of 60% is the correct answer.

As you see you need to know what the normal values are and how to treat abnormalities. You also need to know what equipment does and in what situation to use it in and how to troubleshoot it.

TMC Style Question and Explanation 3

After surgery a 170 lb male is receiving mechanical ventilation using the following settings:

  • Mode AC/VC
  • TV 450
  • F 12
  • FIO2 .45
  • Peep 5

ABGs are just resulted:

  • pH 7.16
  • PCO2 69
  • Po2 58
  • HCO3- 23
  • Sao2 91

Which should the respiratory therapist recommend?

  1. Increase fio2 to 55%
  2. Increase rate to 14
  3. Increase peep to 7
  4. Increase TV to 580

First evaluate the scenario and the laboratory results.  The patient is receiving mechanical ventilation following surgery, no pulmonary history is given. The patient’s pH,co2 and Po2 are abnormal.  Ventilation is necessary for survival so we need to address this before the hypoxia is addressed. The two ways to address the ventilation are to increase the TV and increase the RR. You always want to adjust the tidal volume first before adjusting the rr.

TMC Style Question and Explanation Example 2

A 27 year old hospitalized male with pneumonia has the following laboratory results, the results were obtained when the patient was on 1lpm NC

  • pH7.36 RBC 6.5 mil/mm3
  • paCO2  45Hb
  • paO2 59
  • Sao2 88
  • HCO3-  23
  • Hb 15
  • Hct 47
  • WBC 2500/mm3
  • Temp 39C
  • Bp 128/ 78

What should the respiratory therapist recommend?

  1. Administer antibiotics
  2. Initiate non invasive positive pressure therapy
  3. Initiate pep/ flutter
  4. Increase nc to 4lpm

First think we do is analyze the information and ask the following questions in the following order

  1. Is the patient ventilating? Yes the abg reveals a normal pH and Co2
  2. Is the patient oxygenating? No paO2 is 59 (normal is80-100) Hypoxia must be addressed immediately.
  3. Is the patient circulating and perfusing? Yes
  4. Treating the underlying issue

The correct answer is to increase the NC to 4lpm. Starting antibiotics is also right but oxygenation is an emergency and must be treated before we move on to treating the underlying issue of pneumonia with antibiotics and flutter. If the patient’s oxygenation had been normal we would check the patient’s perfusion and move onto the underlying issue since they are circulating and perfusing.

TMC Style Question and Explanation Example 1

Below is a sample question, similar to ones you might find on the tmc exam. This type of question is an analysis type of question , they are the hardest and the least common type of question on the exam . Analysis questions often give people the most trouble on the exam and is the area that causes most people to fail. Practicing analysis type questions will help you prepare for the exam because it requires you to know the normal values and equipment and how to apply each. This will help you on all the other exam questions.

Following surgery a 39 female, that is 5’6”,145 lbs is receiving mechanical ventilation at the following settings:

  • Mode AC
    • TV 500
    • F 13
    • Peep 5
    • Fio2 .45

The following patient values are available

  • pH 7.38
  • PCO2 46
  • PO2 63
  • HCO3- 23
  • CVP 8 cmHG
  • PAP 15mmHg

The respiratory therapist should recommend the following change

  1. Increase the peep to 8
  2. Increase Fio2 to 55%
  3. Increase  TV to 600
  4. Increase RR to 16

The first thing you do is analyze the information and ask:

  • Is the patient ventilating? Yes, her co2 and pH are normal
  • Is the patient oxygenating? No, her pO2 i s 63 so she hypoxic, this must be treated. Two answers here address hypoxia, peep and fio2 since the fio2 is below 60 we address that first. The correct answer is to increase the fio2 to 55%