The aim of this quasi-experimental study was to incorporate a cardiac simulation into a computer exam for Level 4 nursing students to determine if it would affect their anxiety levels and overall scores. Nursing education must constantly improve as technology and evidence-based practice evolves the world of healthcare. Literature regarding simulation was plentiful; however, the search revealed a gap in the literature regarding the incorporation of simulation into nursing exams. There were two research questions. Research Question 1 asked, "Is there a statistically significant difference in nursing proficiency of nursing students who participate in computer exams that incorporate simulation and nursing students who do not participate in computer exams that incorporate simulation and nursing students who do not participate in computer exams that incorporate simulation?" Research Question 2 asked, "Is there a statistically significant difference in levels of anxiety in nursing students who participate in computer exams that incorporate simulation and nursing students who do not participate in computer exams that incorporate simulation?" Undergraduate senior nursing students were invited to participate on a volunteer basis. The number of students who volunteered to participate resulted in a sample size of 100. The participants were divided into two groups: those who completed computer exams with simulation incorporated (the experimental group) and those who completed computer exams without simulation (the control group). The data included the exam scores with or without the incorporation of simulation and level of anxiety pre- and posttest with or without the incorporation of simulation. There was no statistically significant difference in nursing proficiency of nursing students who participated in computer exams that incorporated simulation and nursing students who do not participate in computer exams that incorporated simulation. Additionally, there was no statistically significant difference between students' levels of anxiety from participating in exams with simulations. The assumption was that examination scenarios in a simulation combined with a computer exam would give nursing students less anxiety and higher proficiency scores, but there was no statistically significant finding to support this assumption. Further research is needed to explore whether participants will excel with the use of simulation incorporated into their exams. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]