Many nursing programs use standardized testing packages in order to evaluate students' content mastery as well as predict probability of passing the National Council Licensure for Registered Nurses (NCLEX-RN). Instead of a diagnosis for weak content areas, programs implement testing policies in the belief that such policies ensure student success on the NCLEX-RN examination. In addition to the use of the standardized examinations to ensure success on NCLEX-RN and in subsequent Registered Nurse (RN) practice, most nursing programs use simulation to prepare students for practice. What is not known is whether simulation promotes better content mastery as students' progress through nursing programs. Therefore the purpose of this study was to determine whether there were significant differences between two student cohorts, one with no exposure to simulation and one with one hour of exposure to simulation, on the Assessment Technology Institute® (ATI) Nursing Care of the Children RN content mastery series (CMS) examination at the end of a pediatric course in a Baccalaureate nursing program. This study also determined that there was a significant difference between Cohort 1 scores and Cohort 2 scores on the ATI® RN Comprehensive Predictor, which these students took upon completion of baccalaureate nursing program. Simulation use demonstrated no statistical significance in high-stakes testing when compared to traditional methods of nursing education. Nursing research needs to move forward and find ways that faculty can become prepared to use best practices regardless of what is being taught to prepare students for licensure. Benner (1984) clearly advocated the importance of experiential learning in nursing curriculum. However, knowing about resources available to improve the overall curriculum is the key to maintaining the high standards expected by stakeholders. The final competency is demonstrated upon passing the NCLEX-RN. With resources made available to faculty by the Quality and Safety Education for Nurses (QSEN) Institute, simulation and high-stakes examinations have two true connections in all areas of the healthcare field, and these are patient safety and patient satisfaction. Clinical decision-making skills are expected upon graduation regardless of practice location (American Association of Colleges of Nursing, 2008). [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.]