Background: Test anxiety is a special kind of anxiety-worry mixed with fear which arises in situations where an individual is being evaluated in an academic context. This anxiety may prevent effective use and communication of the information learned by students for examinations, resulting in poor academic performance. Factors such as examination types and socio-cultural context influence test anxiety in university students. Limited evidence is currently available on the roles played by these factors among nursing students in Saudi Arabia, where strong socio-cultural factors shape university education. Objectives: The study was designed to assess university students’ preferences for various examination types: quizzes, formal exam, Objective Structured Clinical Examination (OSCE), paper based written exam, oral exam, open book exam. The study also determined the association of test anxiety of the students and the results obtained from different examination types. Methods: This descriptive, cross-sectional study was conducted among 135 baccalaureate nursing students at the Umm Al-Qura University, Saudi Arabia. A pre-tested, semi-structured questionnaire was self-administered to the students, covering level of exam fairness, easiness, and the number of study hours required to attend the examinations. The test anxiety level of the students was evaluated using a Westside Test Anxiety Scale. Multivariate analysis of variance was performed to explore the association between test anxiety and socio-demographic characteristics of the students. Results: A total of 135 female nursing students were enrolled into the study. Their ages ranged from 20 to 22 years with mean age of 20.8 ± 0.63. Only 24 (17.8%) of them were married at the time of the study. Fifty-nine participants (43.7%) missed less than three theory lectures while 64 (47.4%) were absent for less than three times in the practical sessions. The most preferred examination type was monthly written examination 43 (31.9%) while 78 (57.8%) students had problematic test anxiety. The most frequent coping mechanisms adopted to manage test anxiety by study participants were psychological support and preparation for the examination (p=0.001 and p=0.031, respectively). No statistically significant association existed between test anxiety and academic performance (p=0.41). However, coping mechanisms such as preparing for the exam and psychological support had a statistically significant relationship with academic performance (p<0.0001 and 0.026, respectively). Conclusion: This study showed that test anxiety and preferences for particular test formats affect the students ability to demonstrate content knowledge. The results suggest the need for school support system to make testing outcomes more equitable for nursing students