This mixed methods participatory action research study investigated student perceptions of stress within the context of a high stakes testing environment. Participants were prelicensure baccalaureate nursing students enrolled in the final semester of their nursing program. The quantitative method, a prospective correlational research design using the Student Nurse Stress Index (SNSI) provided a quantitative measure of stress. Phenomenography, the qualitative method, was used in order to capture the various ways students experience stress. The combination of these two methods provided a rich understanding of student perspectives regarding the use of high stakes testing nursing as a measure of progression toward graduation. Analysis of the research findings revealed all students experience stress while preparing for high stakes testing. However, students perceived the experience of stress in a myriad of ways suggesting that students view high stakes testing as a threat rather than a challenge.