Page 1 of 48
BARKLEY DIAGNOSTIC TESTING PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
DIAGNOSTIC
Prepare for the Barkley Diagnostic Testing Practice Exam with a focused study
resource covering essential diagnostic evaluation concepts for advanced nursing
practice. It supports review of laboratory tests, imaging studies, diagnostic
indications, interpretation of findings, and selecting appropriate tests for common
clinical presentations. Use the material to reinforce knowledge, strengthen clinical
reasoning, and identify areas that may require additional review. This resource is best
suited for nurse practitioner students and certification candidates preparing for
diagnostic testing and board-style assessments.
MULTIPLE CHOICE.
1. A 45-year-old female presents with fatigue, pallor, and shortness of
breath. Her complete blood count (CBC) shows hemoglobin of 8.5 g/dL,
MCV 75 fL, and ferritin 8 ng/mL. Which of the following is the most likely
diagnosis?
A) Iron deficiency anemia
B) Vitamin B12 deficiency anemia
C) Folate deficiency anemia
D) Anemia of chronic disease
Answer: A
Rationale: This patient has microcytic anemia (low MCV) with low ferritin,
which is diagnostic of iron deficiency anemia. Vitamin B12 and folate
deficiency cause macrocytic anemia (elevated MCV). Anemia of chronic
disease is normocytic with normal or elevated ferritin.
, Page 2 of 48
2. A 68-year-old male with a history of hypertension presents with a 2-
week history of fatigue and bone pain. His complete blood count shows
hemoglobin of 10.2 g/dL, WBC 4,500, platelets 120,000. Serum protein
electrophoresis shows a monoclonal spike. What is the most likely
diagnosis?
A) Multiple myeloma
B) Chronic lymphocytic leukemia
C) Waldenström's macroglobulinemia
D) Essential thrombocythemia
Answer: A
Rationale: Multiple myeloma is characterized by anemia, bone pain, and a
monoclonal spike on serum protein electrophoresis (M-spike). The
presence of cytopenias (anemia, thrombocytopenia) and a monoclonal
protein is classic. A bone marrow biopsy confirms the diagnosis.
3. A 55-year-old female with a history of hypothyroidism presents with
fatigue, weight gain, and constipation. Her TSH is 15 mIU/L and free T4 is
0.5 ng/dL. What is the most appropriate next step?
A) Start levothyroxine 25 mcg daily
B) Start levothyroxine 100 mcg daily
C) Order a thyroid ultrasound
D) Refer to endocrinology
Answer: A
Rationale: This patient has primary hypothyroidism (elevated TSH, low
free T4). The initial dose of levothyroxine is typically 25–50 mcg daily for
younger patients and 12.5–25 mcg for older patients or those with cardiac
disease. Starting at 100 mcg is too high.
, Page 3 of 48
4. A 72-year-old male with a history of hypertension presents with a 2-
week history of chest pain with exertion. His resting ECG is normal. What
is the most appropriate next diagnostic test?
A) Exercise stress test
B) Cardiac catheterization
C) CT coronary angiography
D) Myocardial perfusion imaging
Answer: A
Rationale: In a patient with stable chest pain and a normal resting ECG, an
exercise stress test is the appropriate initial diagnostic test to evaluate for
coronary artery disease. Cardiac catheterization is reserved for high-risk
patients or positive stress tests.
5. A 45-year-old female with a history of anxiety presents with palpitations
and shortness of breath. Her TSH is 0.01 mIU/L and free T4 is elevated.
What is the most likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subclinical hyperthyroidism
D) Thyroiditis
Answer: A
Rationale: Suppressed TSH with elevated free T4 and symptoms of
hypermetabolism (palpitations, shortness of breath) is consistent with
Graves' disease. Hashimoto's causes hypothyroidism; subclinical
hyperthyroidism has low TSH with normal free T4.
6. A 60-year-old male with a history of smoking presents with a 3-month
history of a non-productive cough and hoarseness. He has a 40-pack-year
smoking history. What is the most appropriate initial diagnostic test?
, Page 4 of 48
A) Chest X-ray
B) CT of the chest
C) Bronchoscopy
D) Sputum cytology
Answer: A
Rationale: A chest X-ray is the initial imaging test for suspected lung
cancer in a patient with significant smoking history and respiratory
symptoms. CT is indicated if the X-ray is abnormal. Bronchoscopy is used
for tissue diagnosis; sputum cytology has low sensitivity.
7. A 35-year-old female presents with a 2-week history of fatigue, joint
pain, and a malar rash. Laboratory studies show ANA positive 1:320, anti-
dsDNA positive, and low complement levels. What is the most likely
diagnosis?
A) Systemic lupus erythematosus (SLE)
B) Rheumatoid arthritis
C) Sjögren's syndrome
D) Scleroderma
Answer: A
Rationale: This patient meets criteria for SLE with malar rash, arthritis,
ANA positivity, and anti-dsDNA antibodies. Anti-dsDNA is highly specific
for SLE and correlates with disease activity. Rheumatoid arthritis typically
has RF/CCP positivity; Sjögren's has anti-SSA/SSB; scleroderma has anti-
Scl-70.
8. A 55-year-old male presents with a 2-week history of headaches, visual
changes, and palpitations. His blood pressure is 180/110 mmHg. What is
the most appropriate initial diagnostic test?
A) Urinalysis
BARKLEY DIAGNOSTIC TESTING PRACTICE EXAM
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
DIAGNOSTIC
Prepare for the Barkley Diagnostic Testing Practice Exam with a focused study
resource covering essential diagnostic evaluation concepts for advanced nursing
practice. It supports review of laboratory tests, imaging studies, diagnostic
indications, interpretation of findings, and selecting appropriate tests for common
clinical presentations. Use the material to reinforce knowledge, strengthen clinical
reasoning, and identify areas that may require additional review. This resource is best
suited for nurse practitioner students and certification candidates preparing for
diagnostic testing and board-style assessments.
MULTIPLE CHOICE.
1. A 45-year-old female presents with fatigue, pallor, and shortness of
breath. Her complete blood count (CBC) shows hemoglobin of 8.5 g/dL,
MCV 75 fL, and ferritin 8 ng/mL. Which of the following is the most likely
diagnosis?
A) Iron deficiency anemia
B) Vitamin B12 deficiency anemia
C) Folate deficiency anemia
D) Anemia of chronic disease
Answer: A
Rationale: This patient has microcytic anemia (low MCV) with low ferritin,
which is diagnostic of iron deficiency anemia. Vitamin B12 and folate
deficiency cause macrocytic anemia (elevated MCV). Anemia of chronic
disease is normocytic with normal or elevated ferritin.
, Page 2 of 48
2. A 68-year-old male with a history of hypertension presents with a 2-
week history of fatigue and bone pain. His complete blood count shows
hemoglobin of 10.2 g/dL, WBC 4,500, platelets 120,000. Serum protein
electrophoresis shows a monoclonal spike. What is the most likely
diagnosis?
A) Multiple myeloma
B) Chronic lymphocytic leukemia
C) Waldenström's macroglobulinemia
D) Essential thrombocythemia
Answer: A
Rationale: Multiple myeloma is characterized by anemia, bone pain, and a
monoclonal spike on serum protein electrophoresis (M-spike). The
presence of cytopenias (anemia, thrombocytopenia) and a monoclonal
protein is classic. A bone marrow biopsy confirms the diagnosis.
3. A 55-year-old female with a history of hypothyroidism presents with
fatigue, weight gain, and constipation. Her TSH is 15 mIU/L and free T4 is
0.5 ng/dL. What is the most appropriate next step?
A) Start levothyroxine 25 mcg daily
B) Start levothyroxine 100 mcg daily
C) Order a thyroid ultrasound
D) Refer to endocrinology
Answer: A
Rationale: This patient has primary hypothyroidism (elevated TSH, low
free T4). The initial dose of levothyroxine is typically 25–50 mcg daily for
younger patients and 12.5–25 mcg for older patients or those with cardiac
disease. Starting at 100 mcg is too high.
, Page 3 of 48
4. A 72-year-old male with a history of hypertension presents with a 2-
week history of chest pain with exertion. His resting ECG is normal. What
is the most appropriate next diagnostic test?
A) Exercise stress test
B) Cardiac catheterization
C) CT coronary angiography
D) Myocardial perfusion imaging
Answer: A
Rationale: In a patient with stable chest pain and a normal resting ECG, an
exercise stress test is the appropriate initial diagnostic test to evaluate for
coronary artery disease. Cardiac catheterization is reserved for high-risk
patients or positive stress tests.
5. A 45-year-old female with a history of anxiety presents with palpitations
and shortness of breath. Her TSH is 0.01 mIU/L and free T4 is elevated.
What is the most likely diagnosis?
A) Graves' disease
B) Hashimoto's thyroiditis
C) Subclinical hyperthyroidism
D) Thyroiditis
Answer: A
Rationale: Suppressed TSH with elevated free T4 and symptoms of
hypermetabolism (palpitations, shortness of breath) is consistent with
Graves' disease. Hashimoto's causes hypothyroidism; subclinical
hyperthyroidism has low TSH with normal free T4.
6. A 60-year-old male with a history of smoking presents with a 3-month
history of a non-productive cough and hoarseness. He has a 40-pack-year
smoking history. What is the most appropriate initial diagnostic test?
, Page 4 of 48
A) Chest X-ray
B) CT of the chest
C) Bronchoscopy
D) Sputum cytology
Answer: A
Rationale: A chest X-ray is the initial imaging test for suspected lung
cancer in a patient with significant smoking history and respiratory
symptoms. CT is indicated if the X-ray is abnormal. Bronchoscopy is used
for tissue diagnosis; sputum cytology has low sensitivity.
7. A 35-year-old female presents with a 2-week history of fatigue, joint
pain, and a malar rash. Laboratory studies show ANA positive 1:320, anti-
dsDNA positive, and low complement levels. What is the most likely
diagnosis?
A) Systemic lupus erythematosus (SLE)
B) Rheumatoid arthritis
C) Sjögren's syndrome
D) Scleroderma
Answer: A
Rationale: This patient meets criteria for SLE with malar rash, arthritis,
ANA positivity, and anti-dsDNA antibodies. Anti-dsDNA is highly specific
for SLE and correlates with disease activity. Rheumatoid arthritis typically
has RF/CCP positivity; Sjögren's has anti-SSA/SSB; scleroderma has anti-
Scl-70.
8. A 55-year-old male presents with a 2-week history of headaches, visual
changes, and palpitations. His blood pressure is 180/110 mmHg. What is
the most appropriate initial diagnostic test?
A) Urinalysis
