Knowledge acquisition in nursing education is commonly assessed with tests, also called exams, or examinations. Because of their impact on course grades and academic success, tests are a substantial source of anxiety and stress for nursing students and the central unifying theme of this three-manuscript dissertation. There are two high-stakes tests that are particularly important in nursing education: the exit exam and the licensure exam. The exit exam identifies deficiencies in nursing knowledge and clinical judgment and quantifies students' probability of passing the licensure exam, which is the final test of competency for nursing practice. The first manuscript resulted from a retrospective study of two commercially available exit exams that were found to be equally accurate, strong predictors of licensure exam success, but inaccurate predictors of failure. The second manuscript is an integrative review of 33 publications about interventions for the test-related anxiety of prelicensure nursing students. Identified in these publications were 19 different interventions, most of which were found to be effective for managing test-related anxiety. The third manuscript reports a prospective study of stress related to a high-stakes exit exam. Although nursing students appraised the exit exam as a stressful experience, academic concerns beyond the exit exam were greater sources of stress. However, perceived stress before the exit exam was not associated with exam performance. Furthermore, although perceived stress related to the exit exam was greater than perceived stress related to a low-stakes homework assignment, physiological stress reactivity measured with salivary cortisol and salivary alpha-amylase at the time of the exit exam was not significantly greater than physiological stress reactivity measured at the time of the homework assignment, suggesting physiological adaptation to chronic stress. This work implies the need to study the effectiveness of new and previously tested interventions for managing the test-related stress and anxiety of nursing students and minimizing its' impact on academic performance. Future research is also needed to examine the impact of chronic stress in nursing school to licensure exam performance and perseverance in the nursing profession.