A growing need to move didactic instruction to a virtual environment requires nurse educators to adopt creative approaches to online formative assessment strategies. Low-stakes assessments of student comprehension allow teaching approaches to be adjusted quickly in asynchronous virtual environments. A classroom assessment technique commonly known as "the muddiest point" has proven to be useful in gathering feedback from students about concepts they are struggling with and improve comprehension prior to high-stakes examinations. Advanced Pathophysiology is a graduate-level class with 275 nursing students in a mixed online/in-person classroom environment, so traditional paper-based assessment strategies intended for smaller face-to-face classes are not practical. To identify concepts needing clarification, the instructors created a graded muddiest-point assignment to be completed after each lecture, which was worth 2% of the final course grade. Students submitted 2 questions related to concepts they felt were unclear after each lecture in the online course site. Instructors randomly reviewed half of the 550 muddiest points each week and distilled common themes from all submissions. Instructors tailored their next lecture to address 5 themes identified in the muddiest point submissions. Examination scores increased on 2 of 4 examinations compared to the previous year. While some students stated they would rather cover new material than review old concepts, most students believed the activity improved their understanding of course concepts.