Passing the HESI A2 comes down to understanding what’s actually on the exam, focusing your study time on the sections that trip people up most, and practicing under timed conditions. Most nursing programs require a 75% or higher on each section and a 75% composite score, though competitive programs may expect higher. The exam is computerized, covers six core areas, and gives you between 3 and 5 hours depending on your school’s testing format.
What the Exam Covers
The HESI A2 typically includes six sections: grammar, reading comprehension, vocabulary and general knowledge, biology, chemistry, and math. Some programs also require anatomy and physiology or critical thinking. Your nursing school determines which sections you’ll take, so check their specific requirements before you start studying. There’s no point spending weeks on chemistry if your program doesn’t test it.
The anatomy and physiology section, when required, has 30 questions covering general terminology, histology, cell division, and major organ systems. The math section tests basic arithmetic, fractions, ratios, proportions, percentages, and unit conversions. None of the sections require advanced knowledge, but they do require solid fundamentals and the ability to work quickly under time pressure.
Score Requirements Vary by School
A 75% on each sub-test is the baseline at many programs, but don’t aim for the minimum. Your composite score often factors into your application ranking. At the University of Texas Rio Grande Valley, for example, the composite score counts for 20% of your total ranking even though there’s no minimum composite requirement. Other schools weight it differently, but the pattern holds: a higher HESI score makes your application more competitive.
If you fall short, most schools allow at least one retake after a waiting period. Laurel Ridge Community College, for instance, permits one retake following a 7-day wait. Some schools allow two or three attempts per application cycle, while others limit you to one retake per year. Know your school’s retake policy before test day so you can plan accordingly.
How to Study the Math Section
Math is one of the most failed sections, not because it’s difficult, but because people haven’t practiced these skills since high school. The questions cover fractions, decimals, percentages, ratios, proportions, and metric conversions. No calculus, no advanced algebra.
For fractions, make sure you can add, subtract, multiply, and divide them fluently, including with different denominators. When dividing fractions, keep the first fraction, flip the second, then multiply. For proportions, practice cross-multiplication: if you see 6/2 = 12/x, you’d multiply 6 times x and 2 times 12, giving you 6x = 24, so x = 4. These types of problems show up repeatedly.
Metric conversions follow a predictable pattern since metric units move in multiples of 10. A popular mnemonic is “King Henry Died By Drinking Chocolate Milk,” representing kilo, hecto, deca, base, deci, centi, milli. Moving to a smaller unit means multiplying by 10 for each step; moving to a larger unit means dividing. You should also know how to convert between fractions, decimals, and percentages in all directions. To turn a percentage into a decimal, divide by 100. To turn a fraction into a percentage, divide the numerator by the denominator and multiply by 100.
Practice doing all of this by hand. Some testing centers provide an on-screen calculator, but not all do, and relying on one slows you down. Build speed with mental math and pencil-and-paper work.
Tackling the Science Sections
Biology questions focus on cellular biology, genetics basics, photosynthesis, and general life science. You’ll want to understand the differences between mitosis and meiosis, how DNA replication works at a basic level, and the major macromolecules (proteins, carbohydrates, lipids, nucleic acids) and what they do in the body.
Chemistry covers atoms, the periodic table, chemical bonds, acids and bases, and basic chemical reactions. You don’t need to memorize the entire periodic table, but you should understand atomic structure, how ionic and covalent bonds differ, and what pH means in practical terms.
If your program requires anatomy and physiology, focus on body systems one at a time: cardiovascular, respiratory, nervous, digestive, musculoskeletal, endocrine, urinary, and reproductive. For each system, know the major organs, their functions, and how they interact. Also review histology (the four tissue types) and basic cell structure. With 30 questions covering this much material, the questions stay at a survey level rather than diving deep into any single system.
Grammar, Vocabulary, and Reading Comprehension
These sections are easier to underestimate than the math and science portions, but they can sink your composite score if you don’t prepare. Grammar questions test subject-verb agreement, comma usage, commonly confused words (affect vs. effect, then vs. than), and sentence structure. If you’re rusty, work through a grammar workbook or take online practice quizzes until these rules feel automatic.
Vocabulary questions often feature medical and academic terms. You won’t need to know advanced clinical terminology, but words like “bilateral,” “posterior,” “benign,” “exacerbate,” and “lethargic” are fair game. Learning common Latin and Greek roots helps enormously. If you know that “hyper” means excessive and “hypo” means under, you can reason through unfamiliar terms on the spot.
Reading comprehension gives you passages and asks you to identify the main idea, draw inferences, and determine the meaning of words in context. The best preparation is simply reading dense material regularly, whether that’s science articles, nursing textbooks, or long-form journalism. On test day, read the questions before the passage so you know what to look for.
Building a Study Plan
Four to six weeks of focused study is enough for most people, assuming you set aside at least an hour a day. Start by taking a full-length practice test to identify your weakest areas. Then weight your study time accordingly. If you scored 85% on reading comprehension but 60% on math, math needs three times the attention.
Several resources consistently get recommended by students who’ve passed. The official HESI A2 Admission Assessment Exam Review book from Elsevier covers all sections and includes practice questions written in the same style as the real exam. For free options, BoostPrep offers practice tests online, and YouTube channels like Nurse Cheung, NurseHub, and Professor Yu walk through specific sections with explanations. NurseHub also offers a study platform where you can filter practice questions by section.
During your final week, shift from learning new material to taking timed practice tests. The real exam gives you roughly one minute per question, so simulate that pressure. Review every question you get wrong and understand why you missed it. Pattern recognition matters: the HESI A2 tends to test the same concepts in slightly different ways.
Test Day Strategy
With 170 questions and a 3-hour window at many testing centers (some allow up to 4.5 or 5 hours), pacing is everything. That’s roughly one minute per question at the tightest time limits. Don’t spend three minutes agonizing over a single question. Mark it, move on, and come back if time allows.
For math questions, write out your work even if a calculator is available. Careless errors from mental math are the most common way people lose points on questions they actually know how to solve. For reading comprehension, eliminate obviously wrong answers first. The HESI A2 often includes one or two answer choices that are clearly off-topic, which improves your odds even when you’re unsure.
On science questions, watch for absolute language. Answer choices that use words like “always” or “never” are frequently incorrect because biology and chemistry are full of exceptions. Answers with “typically” or “primarily” tend to be safer picks when you’re guessing.
Arrive early, bring valid identification, and eat a solid meal beforehand. The exam is a mental endurance test as much as a knowledge test, and fatigue in the final hour is where avoidable mistakes pile up.