What You Need to Know About Test Anxiety

by J.Adderton J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 29 years experience.

Have you ever drawn a complete blank when answering a test question for material you studied and know? As a nursing instructor, I would often have students come to my office and tearfully described how anxiety prevented them from recalling what they had studied and learned on a test. I would then explain it is normal to have some degree of anxiety with testing. However, there are students who experience extreme anxiety that actually prevents them from performing well. This article will explore test anxiety and provide tips for reducing stress before, during and after exams.

What strategies have helped you to deal with test anxiety?

What You Need to Know About Test Anxiety

Test anxiety is when your anxiety level prevents you from demonstrating what you have learned and know on a test. There are students who feel nervous before a test because they did not prepare adequately or have poor study skills. Anxiety in cases of poor preparation do not qualify as true test anxiety. Students suffering from test anxiety experience extreme nervousness before exams, even when they have put forth their best effort in learning the material and are prepared. For many students, test anxiety began as early as elementary school, although some students develop test anxiety in college. The good news- test anxiety is usually a learned behavior and there are many strategies you can use to "unlearn" the intense nervousness of test anxiety.


Symptoms of test anxiety include mental and physical stress occurring before, during, or after exams. Again, there is a level of expected nervousness that comes with test-taking, however, test anxiety leads to symptoms of greater intensity.


  • Negative thoughts- "There is no way I am going to pass this exam"
  • All or none thinking- "I always have the lowest grade in the class"
  • Irrational beliefs- "The entire class can tell I failed"
  • Mind reading- "My professor thinks I am an idiot"
  • Self pressure- "I absolutely must make an A on this test"


  • Nausea, shortness of breath, muscle tension
  • Clammy hands and feet, sweating, rapid pulse
  • Increased blood pressure, blurry vision
  • Hypersensitive to surroundings (i.e. classroom noise, behavior of other people, watching the clock)
  • Mental blocks when well prepared for test

Anxiety has a cumulative effect and once the ball is in motion, it will build in speed. The first step in overcoming test anxiety is to nip it in the bud before it intensifies. When you first notice the signs of anxiety, it is important you have strategies for reducing stress in your body and mind. Behavioral relaxation techniques help you to achieve a physical state of relaxation. You can relax your mind by cognitive strategies and talking to yourself in a positive way.

Relax Your Body

Deep breathing is an exercise that reduces anxiety and you can do it in the classroom unnoticed. Take a deep breath in using your diaphragm, hold it for several seconds, then exhale slowly thinking of your anxiety leaving the body. A second strategy is to use imagery by imaging yourself in a relaxing scene. The more senses you can incorporate, the better this strategy will work. For example- I would place myself at the beach with the sun's warmth on my skin and cool sand under my feet. I would hear the gentle breaking of waves and smell the salty ocean water. A third strategy is to perform progressive muscle relaxation by tensing then relaxing muscles in your body one by one.

Relax Your Mind

The first step in relaxing your mind prior to a test is to change your self-talk from negative to positive. For example, when thinking "you know you are going to fail", replace the thought with "You are prepared to take this test". Avoid making the situation worse with poor study habits and not preparing adequately for this test. Go to class every day, make notes and talk to your instructor when you have questions. Try visualizing your success by mentally picturing yourself as confident, calm and relaxed when taking the test. Imagine how relaxed you are when you later receive a passing grade.

Here are a few tips for good study and testing skills:

  • Avoid class drama and don't study with classmates that increase your anxiety.
  • Avoid cramming. Last minute studying is a ringer for elevating your anxiety. Start studying for an exam in advance- at least several days before the exam.
  • Study for understanding, not for memorizing. As you read, think about the content and try to understand what you have read before moving to the next topic.
  • Make sure to get a good night sleep the night before the exam.
  • Avoid talking to students who are not prepared or express negativity prior to the exam. Stay relaxed.
  • Be sure to sleep and eat well.
  • Exercise is a great stress reliever so... get up and get moving.
  • Read test directions carefully and budget your time
  • Skip questions you do not know and come back later.
  • Nervous during the test? Take slow and deep breaths.

Anxiety can be habit forming and it takes practice to use these tips and tools to lower your level of anxiety. When you notice your thoughts are racing and your body becoming tense, tell yourself to "STOP" to stop the stress ball from rolling.

What strategies have helped you to deal with test anxiety?


The Princeton Review, 10 Ways to Overcome Stress Anxiety, 1 Ways to Overcome Test Anxiety | The Princeton Review

Study Guides and Strategies, Overcoming test anxiety

Check if your institution's student services offers information on test anxiety.

Nurse with over 20 years nursing experience in a variety of settings including community health, education, management and bedside nursing.

167 Articles   495 Posts

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2 Comment(s)

My school started to mimic the NCLEX in that there was no skipping questions on their exams. That change came inn the Fall 17 semester.They tried to make it closer to the NCLEX experience. I did most of the advice you listed.

Just wondering your take on changing answers.

J.Adderton, BSN, MSN

Specializes in Clinical Leadership, Staff Development, Education. Has 29 years experience. 167 Articles; 495 Posts

If you change an answer- just be sure you did not answer with your gut and now you are reading details to the question. Often students would change a question only to find 2nd choice wrong- they just simply thought about it too much.