Students who experience mathematics anxiety have long been suggested to engage in avoidance behaviors that negatively impact their mathematics performance. However, little is known about how these avoidance behaviors manifest for highly anxious students within the context of a mathematics course. Since the use of effortful study strategies has been shown to be an important predictor of students' academic outcomes, we investigated whether highly mathematics-anxious college students would be less likely to utilize such strategies during exam preparation compared to their less-anxious peers. To measure this, we asked college students (N = 72) enrolled in introductory Calculus to complete a battery of anxiety-related surveys and to retrospectively report how they studied for the final exam in their Calculus course. Using theories of achievement emotion as well as recent research showing a relation between mathematics anxiety and students' planned exam preparation behavior, we hypothesized that students experiencing mathematics anxiety would retrospectively report less engagement with effortful study strategies during exam preparation compared to their less-anxious peers. In line with our hypothesis, we found that solving practice problems was viewed by students as being one of the most effortful ways to prepare for a mathematics examination, and that mathematics anxiety was negatively associated with the proportion of study time students allocated to solving practice problems during exam preparation. These findings highlight the significant relation between mathematics anxiety and students' self-regulated exam preparation behaviors, marking it as an important topic to consider when investigating ways to improve the mathematics performance of highly mathematics-anxious individuals.