Nursing education relies on simulation to provide standardized, safe clinical experiences to prepare nurses for complex patient scenarios. Traditional simulation requires cost-prohibitive equipment and facilities, which are incompatible with complex scenarios and distance learning. Early studies indicate eXtended Reality technology is an effective modality to deliver educational simulation. However, the existing research is not yet conclusive. This study explored the use of a holographic video virtual standardized patient simulation to assess student knowledge, skill, and motivation to learn for a low-frequency, high-risk patient scenario surrounding anaphylaxis. Participating students (n=161) across three levels of nursing courses were stratified and randomly assigned to an anaphylaxis simulation research group delivered by three different modalities. Analysis of covariance showed differences in student knowledge, skill, and motivation to learn between modalities of a written case study, two-dimensional video, and eXtended Reality. These results indicated two-dimensional video provided the highest degree of knowledge and skill, while eXtended Reality simulation resulted in increased student motivation to learn. Stepwise regression indicated that conscious placement of the simulation across the learning continuum should be considered. These results have implications for affordable simulation to motivate learning and provide experiences with low-frequency, high-risk scenarios.