The purposes of this mixed methods explanatory sequential study were: (1) to investigate effects of examination, conducted by the Punjab Examination Commission for grade VIII, on curriculum and instruction, (2) to identify pressures associated with result of the examination, (3) to explore teachers‟ trust in examination, and (4) to identify uses of result of the examination. Five hundred and twenty six elementary school teachers who taught to grade VIII were randomly selected from seven different districts of the Punjab to complete survey in quantitative part of the study. Survey instrument designed for this study contained 112 closed response Likert scale items. Semi-structured interviews were used to collect data for qualitative phase of the study. Maximum variation strategy of purposive sampling was used to select 28 elementary school teachers for qualitative part of the study. These teachers were chosen from larger sample took part in quantitative phase of the study. The purpose of the qualitative part was to further explore quantitative results. The meta inferences revealed that the examination has not only narrowed curriculum and instruction but learning of the students as well. Teachers were pressurized by school principal and district education authority for good result in the examination. Consequences associated with result of examination influenced teachers to use helping books, old exam papers and practice tests in their classes. Most of the teachers used instructional strategies which were teacher centered and focused on drill and practices of the content likely to appear in examination. Teachers were of the view that the examination was not improving education at elementary level because students attempted MCQs without understanding, no or very limited focus on untested subjects and even selective study within tested subjects. Teachers, irrespective of school location and type, shared that the examination was not credible, lacked fairness, invigilation and marking quality was poor and felt threat to their career because of the viii consequences associated with the result of the examination. It was further explored that teachers and school made very limited use of result of examination. Participants of the study were of the view that the examination was not high in stakes for students but it is for teachers. This study has multiple implications for bringing improvement by consulting teachers who are working in the field and confront with the unintended consequences of educational reforms