Date of Award

January 2013

Document Type


Degree Name

Doctor of Philosophy (PhD)


Teaching & Learning

First Advisor

Lars Helgeson


There are many reasons a person may fail a high stakes test such as the National Council Licensure Examination for Registered Nurses (NCLEX-RN®). Sleep deprivation, illness, life stressors, knowledge deficit, and test anxiety are some of the common explanations. A student with test anxiety may feel threatened by this evaluation process. This reaction causes the students to become self-absorbed with altered cognitive abilities such as reduced ability: to concentrate, to remember, and/or to retrieve information, thus lowering the students' performance. This research study explored the correlation among factors such as stress, test anxiety, and student expectations that may be predictive of success or failure in passing the NCLEX- RN® exam. This study also compared the methods of Emotional Freedom Techniques (EFT) to Guided Imagery regarding the reduction of test anxiety and success in passing the NCLEX-RN® exam. Emotional Freedom Techniques, a form of energy psychology, works by having an individual concentrate on a specific psychological issue while simultaneously tapping on specific meridian points. Guided Imagery, a well-respected form of meditation, utilizes directed and focused thought and imaginations.

The participants of this quantitative study were nursing students enrolled in a NCLEX Review course at a university in the Midwest. Randomized groups received two treatment sessions. The students completed the Test Anxiety Inventory (TAI), Westside Test Anxiety Scale, Stress Vulnerability Questionnaire, Subjective Units of Disturbance Scale (SUDS), and had their blood pressure taken before and after treatments. The students also completed the SA-45 Symptom Assessment (SA-45TM), a Personal Profile Data Sheet, and three Student Perception Surveys.

The results of the study showed scoring below an 80% on the HESI Exit Exam and obtaining a lower score on a retake of the HESI Exit Exam was associated with the pass rate of the NCLEX-RN® exam. There was a statistical significant difference in the SUDS rating recorded pre-treatment versus post-treatment which indicated the treatment lowered distress levels in both groups. The systolic and diastolic blood pressure showed a statistical significant decrease in Group 1 (Guided Imagery) after the second treatment. The diastolic blood pressure showed a statistical significant decrease after the second treatment in Group 2 (EFT). There was a statistical significant difference in the Westside Test Anxiety incapacity (memory) subscale before treatments and after treatments in Group 2 (EFT). On Student Perception Survey 3, at the end of the study, Group 2 (EFT) reported a decrease in test anxiety while Group 1 (Guided Imagery) conveyed a slight increase. Both groups reported they thought the treatment were effective. Emotional Freedom Techniques did reduce test anxiety in high stakes testing.