High fidelity patient simulation (HFPS) has become an increasingly popular teaching methodology in nursing education. To date, there have not been any published studies investigating HFPS scenarios incorporating medical and psychiatric nursing content. This study utilized a quasi-experimental design to assess if HFPS improved student knowledge and retention of knowledge utilizing three parallel 30-item Elsevier HESI(TM) Custom Exams. A convenience sample of 37 senior level nursing students participated in the study. The results of the study revealed the mean HESI test scores decreased following the simulation intervention although an analysis of variance (ANOVA) determined the difference was not statistically significant (p = .297). Although this study did not reveal improved student knowledge following the HFPS experiences, the findings did provide preliminary evidence that HFPS may improve knowledge in students who are identified as "at-risk." Additionally, students responded favorably to the simulations and viewed them as a positive learning experience.