anxiety, cortisol, high-stakes examinations, metabolic stress response, nursing education



  1. Clutter, Lynn B. PhD, APRN, CNS, CNE
  2. Potter, William T. PhD
  3. Alarbi, Ahlam BS
  4. Caruso, John F. PhD, ED-HPES


Stress, in the form of test anxiety, inhibits examination performance essential to nursing success. Salivary cortisol, a biomarker of stress, was obtained before 3 examinations and 1 nursing didactic class from a sample of baccalaureate nursing students in a midwestern US university. Significant differences were found between cortisol sampling events and by junior or senior status. These findings suggest that diverse examinations and program level yield differences in stress for students.