Barkley Diagnostic Testing Practice
Exam
Table of Contents
1. Introduction and Exam Overview
2. Section 1: Cardiovascular Diagnostic Testing (Questions 1-
25)
3. Section 2: Respiratory Diagnostic Testing (Questions 26-50)
4. Section 3: Neurological Diagnostic Testing (Questions 51-
75)
5. Section 4: Endocrine & Metabolic Diagnostic Testing
(Questions 76-100)
6. Section 5: Gastrointestinal & Genitourinary Diagnostic
Testing (Questions 101-125)
7. Section 6: Musculoskeletal & Rheumatologic Diagnostic
Testing (Questions 126-150)
8. Section 7: Hematologic & Oncologic Diagnostic Testing
(Questions 151-175)
9. Section 8: Infectious Disease & Multisystem Diagnostic
Testing (Questions 176-200)
10. Answer Key Summary with Rationales
Introduction and Exam Overview
The Barkley Diagnostic Testing Practice Exam is designed to
strengthen clinical reasoning and diagnostic test interpretation
, skills essential for nurse practitioner practice. Diagnostic testing
is a core competency tested on all NP certification
examinations, including ANCC and AANP boards, and Barkley's
review materials emphasize laboratory/diagnostic test
interpretation across all specialties.
Barkley's Curriculum Review books include over 600 practice
questions covering assessment, labs/diagnostics,
management/treatment, pharmacology, and professional
practice for Adult-Gerontology Primary Care NPs. For PMHNPs,
the curriculum review includes over 325 practice questions
covering diagnosis, laboratory/diagnostics, assessment,
pharmacology, management/treatment, and professional
practice.
Core domains tested include:
• Selection and interpretation of laboratory tests
• Diagnostic imaging modalities (X-ray, CT, MRI, ultrasound)
• Cardiovascular diagnostics (ECG, echocardiography, stress
testing)
• Pulmonary function testing and ABG interpretation
• Neurological diagnostics (EEG, lumbar puncture, imaging)
• Endocrine and metabolic testing
• Gastroenterological and genitourinary diagnostics
• Rheumatologic and musculoskeletal testing
• Hematologic and oncologic testing
• Infectious disease testing
This comprehensive practice exam contains 200 questions
covering diagnostic testing across all major body systems. Each
question includes the correct answer marked in italics with a
detailed rationale in bold.
,Section 1: Cardiovascular Diagnostic Testing (Questions 1-
25)
1. A 58-year-old male presents with substernal chest pain.
Which laboratory test is most specific for myocardial
injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Correct Answer: B
Rationale: Cardiac troponin I is the most specific and
sensitive biomarker for myocardial injury. It rises within 3-6
hours, peaks at 12-24 hours, and remains elevated for 7-10
days. CK-MB is less specific; myoglobin rises early but is not
specific; LDH is a late marker.
2. A patient presents with suspected heart failure. Which
biomarker is most useful for diagnosis and management?
A. BNP
B. Troponin
C. CK-MB
D. CRP
Correct Answer: A
Rationale: B-type natriuretic peptide (BNP) is released by
ventricular myocytes in response to stretch and volume
overload. BNP >100 pg/mL suggests heart failure; levels
correlate with severity and prognosis.
, 3. An ECG shows ST elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
Correct Answer: C
Rationale: Leads II, III, and aVF are inferior leads. ST
elevation in these leads indicates inferior wall MI, most
commonly due to right coronary artery occlusion.
4. A patient has a positive D-dimer but no symptoms of
thrombosis. What is the most appropriate next step?
A. Start anticoagulation
B. CT pulmonary angiography
C. Venous duplex ultrasound
D. Assess pretest probability
Correct Answer: D
Rationale: D-dimer has high sensitivity but low specificity.
It should only be ordered when clinical pretest probability
is low. If pretest probability is high, imaging should be
performed regardless of D-dimer.
5. Which ECG finding is most consistent with hyperkalemia?
A. Peaked T waves
B. U waves
C. ST depression
D. Prolonged QT interval
Correct Answer: A
Exam
Table of Contents
1. Introduction and Exam Overview
2. Section 1: Cardiovascular Diagnostic Testing (Questions 1-
25)
3. Section 2: Respiratory Diagnostic Testing (Questions 26-50)
4. Section 3: Neurological Diagnostic Testing (Questions 51-
75)
5. Section 4: Endocrine & Metabolic Diagnostic Testing
(Questions 76-100)
6. Section 5: Gastrointestinal & Genitourinary Diagnostic
Testing (Questions 101-125)
7. Section 6: Musculoskeletal & Rheumatologic Diagnostic
Testing (Questions 126-150)
8. Section 7: Hematologic & Oncologic Diagnostic Testing
(Questions 151-175)
9. Section 8: Infectious Disease & Multisystem Diagnostic
Testing (Questions 176-200)
10. Answer Key Summary with Rationales
Introduction and Exam Overview
The Barkley Diagnostic Testing Practice Exam is designed to
strengthen clinical reasoning and diagnostic test interpretation
, skills essential for nurse practitioner practice. Diagnostic testing
is a core competency tested on all NP certification
examinations, including ANCC and AANP boards, and Barkley's
review materials emphasize laboratory/diagnostic test
interpretation across all specialties.
Barkley's Curriculum Review books include over 600 practice
questions covering assessment, labs/diagnostics,
management/treatment, pharmacology, and professional
practice for Adult-Gerontology Primary Care NPs. For PMHNPs,
the curriculum review includes over 325 practice questions
covering diagnosis, laboratory/diagnostics, assessment,
pharmacology, management/treatment, and professional
practice.
Core domains tested include:
• Selection and interpretation of laboratory tests
• Diagnostic imaging modalities (X-ray, CT, MRI, ultrasound)
• Cardiovascular diagnostics (ECG, echocardiography, stress
testing)
• Pulmonary function testing and ABG interpretation
• Neurological diagnostics (EEG, lumbar puncture, imaging)
• Endocrine and metabolic testing
• Gastroenterological and genitourinary diagnostics
• Rheumatologic and musculoskeletal testing
• Hematologic and oncologic testing
• Infectious disease testing
This comprehensive practice exam contains 200 questions
covering diagnostic testing across all major body systems. Each
question includes the correct answer marked in italics with a
detailed rationale in bold.
,Section 1: Cardiovascular Diagnostic Testing (Questions 1-
25)
1. A 58-year-old male presents with substernal chest pain.
Which laboratory test is most specific for myocardial
injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. LDH
Correct Answer: B
Rationale: Cardiac troponin I is the most specific and
sensitive biomarker for myocardial injury. It rises within 3-6
hours, peaks at 12-24 hours, and remains elevated for 7-10
days. CK-MB is less specific; myoglobin rises early but is not
specific; LDH is a late marker.
2. A patient presents with suspected heart failure. Which
biomarker is most useful for diagnosis and management?
A. BNP
B. Troponin
C. CK-MB
D. CRP
Correct Answer: A
Rationale: B-type natriuretic peptide (BNP) is released by
ventricular myocytes in response to stretch and volume
overload. BNP >100 pg/mL suggests heart failure; levels
correlate with severity and prognosis.
, 3. An ECG shows ST elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main
Correct Answer: C
Rationale: Leads II, III, and aVF are inferior leads. ST
elevation in these leads indicates inferior wall MI, most
commonly due to right coronary artery occlusion.
4. A patient has a positive D-dimer but no symptoms of
thrombosis. What is the most appropriate next step?
A. Start anticoagulation
B. CT pulmonary angiography
C. Venous duplex ultrasound
D. Assess pretest probability
Correct Answer: D
Rationale: D-dimer has high sensitivity but low specificity.
It should only be ordered when clinical pretest probability
is low. If pretest probability is high, imaging should be
performed regardless of D-dimer.
5. Which ECG finding is most consistent with hyperkalemia?
A. Peaked T waves
B. U waves
C. ST depression
D. Prolonged QT interval
Correct Answer: A
