Welcome to Lesson 1

Test Tips 

Read about the exam ... your "enemy" to conquer 

What if we told you that because this is a standardized exam it is also a very predictable exam? Terminology has to be predictable. Ranges have to be predictable. Even what is covered is predictable. 

This list we put together covers everything from the ways you can take the exam, passing scores, understanding how many questions are on a test, etc. We recommend taking a look through the questions. 

Test Tips

Read our Strategies for Exam Questions

How about some basic strategies on how to approach various types of questions on a standardized exam? You might already have your own strategies - great, too! 

Practice

Take the NBRC's Free 140-Question (full-length) Practice Test

Not all professional exams out there give you a content outline (a basic list of what can be covered on the exam), and they definitely don't always give a free practice exam. Free! 

This is a full-length (140 questions), scored, untimed exam. You will need to sit and take it at one time (you can't save it and come back to it). Note: if you choose to time yourself, know that the actual exam is 3 hours, but for 160 questions (20 questions don't count towards your score).

Why we recommend taking this practice exam: 

• It gives you a good sense for how the NBRC thinks ... how the questions are organized, and what kind of mix of questions/categories you'll find. 
  
  
  • As you read questions, pay attention to how things are worded. You'll quickly see that how the NBRC words things is critical and predictable. Asking you for the FIRST thing you would do suggests there might be multiple correct answers, but only one MOST correct one. 
    
    
    
• The score you receive is categorized into major areas and minor areas. This gives you a bit of an idea of what areas you scored less well on (study these a bit more diligently) and where your current strengths are. 
  
  
• Your final score doesn't matter much. First off, this exam is not exactly representative of the actual NBRC exam (it's fairly close), so it might not reflect what you would get if you took the NBRC exam today. Second, you likely haven't studied yet. This is a pretest, not a posttest. 
  
  >>We don't own or support this practice test. This is a courtesy link to their site. It includes the correct answers but no explanations.

Welcome to Lesson 2  

 Test Tips  

Understanding How Normal Values/Ranges Work 

It can feel frustrating trying to figure out what values you should memorize. Egan's says one thing. The hospital says another. Maybe a PowerPoint has another (I've even been known to unintentionally put different ranges on different slides - insert eye-roll here). 

Here's the thing ... values and ranges are based on measuring devices that have slightly different calibrations. Values that come from equations ... well, there can be more than one acceptable equation out there. 

Read this to see why it just doesn't matter that much. Mostly. 

 Pharmacology 

There is, as you might expect, a fair amount of pharmacology on the TMC exam. It can feel a bit overwhelming when you look at it all, but, as you might also expect, much of it is focused on just a few classifications (we are looking at you, respiratory drugs). 

We have created a summary table that has everything you will need to know. After lots of practice with this, we have found that most people seem to do best by reviewing the drugs in clumps (when you look at them all at once, they become ... blah, blah, blah). Feel free to break the rules if that's how you roll, but we have divided them up and integrated them into the lessons. 

x

 Review 

Patient Assessment 

No matter how many patient assessment questions the NBRC says will be on your exam, there will be more. Lots more. So microwave some popcorn, make a cup of coffee, put your feet up, and spend some time with this section. 

Focus on knowing normals, major causes of abnormal findings, and any connections (for example, what patient assessment findings would you expect with secretions ... it's usually the combination of assessment findings that provide helpful clues)

Let's Open up That Medical Record

... and Assess Our Patient

 Review 

Respiratory Diagnostic Procedures 

There are approximately 30 questions that cover procedures, everything from 12-lead ECGs, PFTs, hemodynamics, and more. What's important for each is reviewed, but be sure to keep your mind focused as you should be able to answer 3 main questions: 

1. When should the procedure be recommended? (and when should it not?!) 
   
   
2. What are the major steps to performing the procedure? 
   
   
3. How do you utilize the results of the procedure?

 Practice 

Lesson 2 Quiz 

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

Welcome to Lesson 3

 Pharmacology 

Our focus on respiratory drugs continue. Remember, these drugs will show up much more frequently than non-respiratory drugs. You can increase your score by spending time making sure you know these well!

 Review 

Respiratory Equipment

The equipment section (approximately 15 questions) is specifically testing your knowledge of how to safely and properly use equipment. You should review each topic, spending more time with topics that you don't feel overly confident about, and be able to answer a few questions for each: 

1. When is the equipment used? As important - when is it not used? 
   
   
2. What are appropriate settings/considerations for each? 
   
   
3. What possible troubleshooting issues might you come across? 
   These are KEY areas that can be tested

 Practice 

Lesson 3 Quiz
(20 min timed)

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material.  

Take Quiz

Welcome to Lesson 4

 Pharmacology 

 It is time to move on to drugs that have an indirect impact on respiratory status. Pain, sedation, and paralytics are first up. Things to remember as you review this section: 

• Some drugs used for pain (opioids like morphine, benzodiazepines) may cause respiratory depression. Recognize which drugs have that potential, how to reverse if necessary, and always ensure you are making recommendations to provide adequate respiratory supports (bag-mask ventilation, for example)
  
  
• Paralytics should never be administered without sedation: the telltale sign that this has been done are vital signs that are "screaming" - HR, BP ... RR won't go up as the patient is paralyzed. 

 Review 

Quality Control 

The bad news? Most people do not particularly enjoy the quality control side of clinical life. The good news? There's only an average of 3 questions covering this area. In general, these questions will be about the basics of calibrating equipment (O2 analyzers, etc.), and performing maintenance or preventative maintenance. 

 Review 

Infection Control 

Your focus in this section is on the specific techniques used for maintaining infection control on equipment (cleaning, disinfecting, and sterilizing), as well as basic management of biohazards. You may even face a real basic question about PPE and what's appropriate when. 

Put my PPE on Now

 Practice 

Lesson 4 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

Welcome to Lesson 5

 Pharmacology 

Vasopressors, inotropics, and other drugs that may have a hemodynamic effect. 

Go Review the Drugs

 Review 

Airway Management

This section contains a lot of applied and analytical information, so as you read through, think in scenarios ... answer questions that are less memorization and more analysis. For example, these are questions we asked as we looked through the list quickly:  

1. What signs might indicate a lack of humidification in an intubated or trach'ed patient? How do you "fix" it?
   
   
2. What signs might indicate a need to exchange an airway? How do you do that safely? 
   
   
3. When is an oropharyngeal tube preferred over a nasal one? What happens for either if they are incorrectly sized? 
   
   
4. When can a speaking valve be recommended? When is it not appropriate? 

 Practice 

Lesson 5 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

Welcome to Lesson 6

 Pharmacology 

There are only a few drugs in this lesson's review. The one that you should review carefully is furosemide (Lasix). As you likely know, it is used consistently to help manage fluid balance issues. Fluid overload can complicate respiratory management (think pulmonary edema), especially in patients with an already fragile status.

 Review 

Airway Clearance
Lung Expansion

There are times when I feel like the most important thing we can do clinically is manage lung expansion (even if it's a simple, "take a deep breath, please.") and airway clearance (even if it's a simple, "okay, give me a good strong cough!"). There are, however, only around 5 questions in this area. Six topics. It means a question from each, maybe. You should plan to have a basic understanding of each, and especially focus on adverse effects, expected effects, and troubleshooting for each therapy. Want a few questions to focus on? 

1. What are the ways to improve lung expansion (hint: it's not always directly respiratory therapy, either!)?
   
   
2. How do you improve airway clearance in a patient with extra secretions? Thick or abnormal secretions? In someone without the ability to cough? 
   
   
3. How often should you suction a patient? 
   
   
4. What positions can we use to drain specific lung regions? What if those secretions are infectious? 

 Practice 

Lesson 6 Midterm Length Quiz

This is a longer quiz, a review of the first 6 lessons with a heavier emphasis on lesson 6 (airway clearance, lung expansion, diuretics). 

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

Welcome to Lesson 7

 Pharmacology 

Have you ever had a junk drawer in your kitchen (or bedroom, perhaps)?  This drawer becomes a magnet for things that don't have a home elsewhere.  Ahh, you see where we are going with this, don't you? These drugs are those drugs that live in the junk drawer of our drug table.  Enjoy. 

 Review 

Oxygenation and Ventilation

Let's get centered, first: 15ish questions, definitely enough to make a difference in your final score. It is 9 sections long, but really can be thought of as a continuum of steps in the management of a deteriorating patient: 

1. Oxygen Therapy: how much to give with the goal of increasing PAO2 (P-BIG-A O2, or alveolar oxygen)
   
   
2. High Flow: O2 is one thing, but flow is another consideration, especially for atelectasis, airway collapse, etc. 
   
   
3. Noninvasive Ventilation: usually by face mask (could be nasal if neonatal/infant - who are obligate nasal breathers)
   
   
4. Invasive Ventilation: Everything from initiating a ventilator, setting alarms, managing settings by oxygenation/ventilation, some troubleshooting (including dyssynchrony, graphics, lung recruitment)
   
   
5. High-Frequency Ventilation: Typically recommended when normal invasive strategies (usually high PEEP, high FIO2) are ineffective
   
   
6. Weaning strategies: Wean FIO2 incrementally, then flow. Stabilize ventilation. Then, wean regularly by performing an SBT. 

 Practice 

Lesson 7 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

 Welcome to Lesson 8

 Pharmacology 

For each lesson, you have been reviewing a segment of the Pharmacology drug table. We hope by now you've brushed up on some of the important drugs you might see on the exam. For this lesson, you should spend some time reviewing them on a whole ... and that will include reviewing some drugs from many lessons ago, those all-important respiratory drugs.  

 Review 

Respiratory Care Plan Modifications

Almost 20 questions! In our experience in reviewing results, this area can be a challenge for many people - it results in some of the lowest scores. It requires you to analyze information (17 of 18 average questions are applied or analytical ... thinking questions), and then make a decision about how to improve a patient's condition. 

These are, basically, problem-solving questions. Your goal is to form an opinion about the information you've received (sometimes my opinion is simple: the patient looks good and I need to start backing off of something, or the patient doesn't look good - I don't know what yet but I need to do something), then review the answer choices and see which make sense (or - as importantly - do not make sense) for that patient clinically. 

Plans are Made for Changing

 Practice 

Lesson 8 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

 Welcome to Lesson 9

 Review 

Evidence-Based Medicine Principles

For exam purposes, understanding this section is about knowing that there are some major guidelines out there that help us make clinical decisions. Guidelines that were developed as a result of research, sometimes lots of it. Examples you've maybe heard of (or should hear of!) include ARDSnet, GINA (asthma), and GOLD (COPD). You should feel comfortable making general decisions within those guidelines. For example: 

• What are the guiding principles of ARDSnet with ventilator management? Is it just low VT? 
  
  
• What next step (usually pharmacology) should you recommend in a patient with asthma who uses a rescue inhaler but whose symptoms aren't improving? 
  
  
• What should you keep in mind for a COPD patient with numerous hospitalized exacerbations in a few months? 

 Review 

High-Risk Situations  

If we were your tour guide driving through these topics (I guess we kind of are, right?), we would point out disaster management and transport but would spend most of our time talking about cardiopulmonary emergencies (important!) and medical emergency teams (important!).  Still review the others but our feeling is that much of that material is common sense.    

 Review 

Assisting the Physician in Performing Procedures 

The skills covered in this area are ones we don't (usually) perform independently (moderate sedation, thoracentesis, cardioversion) so the focus will be on what you do as you are assisting.  VERY often this will involve assessment of the patient's respiratory status (hello, you adorable capnographer), maintaining a patent airway (open wide so I can see those terrific tonsils), and management of the ventilator. 

 Practice 

Lesson 9 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

 Welcome to Lesson 10

 Review 

Patient and Family Education

There are only a few questions here, and those are pretty predictable. A patient is going home, or is home, and needs sufficient education on the use and selection of equipment, management of a disease, including lifestyle management, and recommendations for improvement (pulmonary rehab, for example). A few questions you may want to be able to answer: 

1. What equipment choices (drug delivery devices, airway clearance, lung expansion) make the most sense at home ... integrated into as normal a life as possible? 
   
   
2. Who should education occur with? Just the patient? Does it vary with different conditions? 
   
   
3. What recommendations should you make to ensure that equipment is kept clean/disinfected in a home environment? 
   
   
4. When should pulmonary rehab be recommended? What are its goals? 

 Review 

Diseases and Disorders 

Welcome to one of the two major tables you should study from as you go through Oakes Academy (the other is pharmacology). We have put a tremendous amount of time into creating a resource that will guide you through the most common areas of questioning on exams, including the NBRC. Diseases are presented in order of the anticipated number of questions ... so for the most part, you should plan on spending more time at the top of the table than at the bottom.

In general, really general, you should be prepared to read a question through the goggles of a disease. For example, if I'm intubating a patient with a C-spine issue, I need to remember that how I intubate, how I perform airway clearance, how I ventilate, it is all affected by the disease/disorder.  More specifically, be prepared to answer the following for each disease:

1. Are there ways in which the disease/disorder is diagnosed (or suspected)? 
   
   
2. Are there levels of severity and what are they? 
3. What are the keys to management (treatments, pharmacology, etc.)? Are there exceptions? 
   
   
4. If it is a chronic disease: are there exacerbations? What are the signs? How are they managed? How are long-term treatments altered to manage the exacerbation? 

 Practice 

Lesson 10 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

 Welcome to Lesson 11

 Review 

Neonatal and Pediatrics

You should see somewhere around 7 questions that specifically cover neo/peds. This is an easy area to gain a few points in, so don't avoid it if you're a "I prefer adult care" kind of person (some of us get intimidated by Neo/Peds!). Here are the quickest ways to gain points:

1. Know the basic normals (HR, RR, VT) 
   
   
2. Be able to assess using scales (APGAR especially)
   
   
3. Know what distress looks like (specifics of WOB, how that changes as children age, etc.)
   
   
4. Know what interventions make sense (neo in particular ... where we don't always clinically intervene until the HR drops and holds 

 Review 

Study for Next Lesson's Final Length Practice 

At this point you have reviewed all the content that you might see on your TMC. You probably have a sense of areas you feel extra strong in, and other areas you might question yourself still. Use that feeling to help guide where you spend time. A couple of other suggestions we have: 

1. Use our Content Outline, based on the NBRC's version. 
   As you read through each line, quiz yourself briefly on what that section covers. Got it down? Need to review?
   
   
2. Go Through each Page
   focus on a) Oakes Academy Tips, as these are meant to help guide you, and b) headings for each topics 

 Practice 

Lesson 11 Quiz

We believe one of the absolute best ways you can prepare for the NBRC is to take as many practice questions as possible. We have worked to make each quiz meaningful, and all questions have "teaching explanations" to help further reinforce the material. 

 Welcome to Lesson 12

 Practice 

Final Length Practice 

As you finish preparing we strongly recommend (why? because otherwise you won't really know what to do with the final score/categories):

1. Set a period of time aside to take this in one sitting. You will have THREE HOURS to complete this. 
   
   
2. Avoid the use of any help-aids. Don't look answers up from our site. Don't Google answers. Don't phone a friend. This is you vs. the test, just like the real deal. 
   (do feel free to use a basic calculate and scrap paper)

What to do with the Results

At some point you should receive access to your total score, including a breakdown by category, and an answer key with all the explanations for answer choices. Our recommendation from here: 

1. The score: this is not the NBRC and our goal is to make our test slightly more difficult than the NBRC's (by 5-10 points for most people). 
   
   
2. Study through the test. This could take some time. Focus mostly on questions you missed (or those you think you "guessed right"), but also read through the ones you got right. Our goal is to teach through explanation. 
   
   
3. If there are particular categories you scored low in, go back and review those. 
   
   
4. Then, finally, retake the final if you're able to. You may be amazed at how much more makes sense already (ask your instructor about specific guidelines for retaking the final)