The HESI exam is a standardized test used by nursing schools across the United States to evaluate students at two critical points: before they enter a program and before they graduate. HESI stands for Health Education Systems, Inc., the company that developed it. There are actually two main versions: the HESI A2, which is an admissions test, and the HESI Exit Exam, which measures whether graduating students are ready to pass the national nursing licensing exam (NCLEX-RN).
The HESI A2: Nursing School’s Entrance Exam
The HESI A2, short for Admission Assessment, is a computerized multiple-choice exam that nursing programs use as both a screening tool and a diagnostic tool. A strong score can make a real difference in securing a spot in a competitive program, since many schools rank applicants partly on their HESI results. The exam evaluates knowledge in three broad areas: English language skills, math, and science.
Within those categories, the specific subjects tested include:
- Reading Comprehension (55 questions)
- Vocabulary (55 questions)
- Grammar (55 questions)
- Math (55 questions)
- Anatomy and Physiology (30 questions)
Some schools also require sections in biology, chemistry, and physics, though not all programs include every section. For instance, many community colleges skip the biology and chemistry portions entirely. Your nursing program’s application page will specify exactly which sections you need to complete. An on-screen calculator is available during the math portion, and each section is separately timed and scored.
The vocabulary section goes beyond simple definitions. You’ll encounter questions about prefixes, suffixes, and word roots, testing your ability to figure out the meaning of unfamiliar medical-sounding terms. The math section emphasizes healthcare-relevant computations like dosage calculations and unit conversions alongside basic algebra and fractions. The English language portion is split across three separately scored exams, making it the largest chunk of the test for most students.
The HESI Exit Exam
The HESI Exit Exam, sometimes called the E2, serves an entirely different purpose. Nursing programs administer it during the final semester of the program to gauge whether students are prepared to sit for the NCLEX-RN, the licensing exam every nurse must pass to practice. It’s a comprehensive, computerized test covering clinical nursing knowledge rather than the foundational academics tested on the A2.
The Exit Exam has been used for over two decades, and the data behind it is striking. Students who score 850 or above pass the NCLEX-RN on their first attempt 96.33% of the time. Those who score 900 or higher pass at a rate between 96.4% and 99.2%, based on twelve large-scale studies. Many nursing programs set minimum Exit Exam scores as a graduation requirement or use the results to identify students who need additional review before taking the NCLEX.
How HESI Scoring Works
HESI scores don’t follow a simple percentage system. Instead, scores fall on a scale that typically ranges from around 0 to over 1,000. A score of 900 converts roughly to a 90%, while 850 converts to about 80%. Schools set their own minimum benchmarks, but 850 is a common passing threshold. Below that, scores drop off sharply in their grade equivalents. An 800, for example, translates to just 50%, and anything below 750 sits at 40% or lower.
Each section of the HESI A2 receives its own individual score, and most programs look at both individual section scores and an overall composite. Some schools weigh certain sections more heavily than others during the admissions process, so it’s worth checking what your target program prioritizes.
Cost, Registration, and Retakes
The HESI A2 typically costs around $94 as an administration fee, though the exact price varies by testing location and can change without notice. You’ll register through the testing center at your chosen school or testing site, and payment is usually by credit or debit card. Testing fees are non-refundable and non-transferable, so be sure you’re ready before you register.
If your first attempt doesn’t go well, HESI policy requires a minimum three-week waiting period before you can retake the exam. Many schools add their own restrictions on top of that. The University of Texas Rio Grande Valley, for example, allows only two attempts per academic year. Retake policies differ widely from school to school, so check with your program before assuming you’ll have unlimited chances.
HESI A2 vs. the TEAS
The other major nursing admissions test is the ATI TEAS, and most schools accept one or the other, not both. The two exams differ significantly in depth and length. The HESI A2 has around 350 questions and tests more specialized knowledge across more content areas, including separate sections for anatomy, biology, chemistry, and physics depending on the program. The TEAS has 170 questions (only 150 scored) organized into four broad categories: reading, math, science, and English.
The practical difference comes down to depth versus breadth. The TEAS tests generalized academic knowledge with more straightforward question categories. The HESI requires you to master more specialized material, particularly in the sciences, where each discipline gets its own dedicated section. If you have a strong science background, the HESI may play to your strengths. If you prefer a shorter, more broadly focused exam, the TEAS might feel more manageable. Either way, check which test your target nursing program requires before you start studying.
How to Prepare
The English and math sections tend to be the longest portions of the HESI A2, each with 55 questions. The science sections have fewer questions per subject (the anatomy and physiology section has 30) but cover material that many students haven’t reviewed since their prerequisite courses. Prioritizing your weakest areas makes the biggest difference, but most test prep experts recommend giving extra attention to vocabulary and anatomy, since those sections require the most memorization.
For vocabulary, focus on learning common medical word roots, prefixes, and suffixes rather than memorizing individual definitions. If you can break down an unfamiliar word into its components, you can often figure out the answer even when you haven’t seen the term before. For math, practice healthcare-specific calculations like dosage problems, metric conversions, and ratio and proportion questions alongside basic arithmetic, fractions, and percentages. The science sections reward solid foundational knowledge from your prerequisite biology, chemistry, and anatomy courses more than deep or advanced understanding.
Free practice tests and video tutorials are available through many college library websites and test prep platforms. Starting your review four to six weeks before your test date gives most students enough time to identify gaps and work through them without cramming.