The HESI A2 (Health Education Systems, Inc. Admission Assessment) is a standardized entrance exam used by nursing and allied health programs to evaluate whether applicants have the academic foundation needed to succeed. It covers eight main subject areas: Mathematics, Reading Comprehension, Vocabulary, Grammar, Biology, Chemistry, Anatomy and Physiology, and Physics. Most schools don’t require all eight, so the specific sections you’ll take depend on your program’s requirements.
How the Exam Is Structured
The HESI A2 is entirely multiple choice. The four English and math sections each contain 50 scored questions plus 5 unscored (pilot) questions mixed in, so you won’t know which ones count. The four science sections are shorter, with 25 scored questions and 5 unscored questions each. You get a total of three hours to complete the exam, including short breaks, and the clock doesn’t pause. Once time expires, the test ends automatically.
Beyond the academic sections, many schools also include a Personality Profile and a Learning Style assessment. The Personality Profile is 15 to 20 questions about your behavioral tendencies and traits. It isn’t scored in the traditional sense and won’t affect your overall results. It gives program directors a general sense of your fit for a healthcare career.
Mathematics
The math section tests practical, applied math rather than advanced algebra or calculus. You’ll work with fractions, decimals, ratios, proportions, and percentages. A significant portion of the questions involves unit conversions: metric to standard, standard to metric, and conversions within each system. Expect questions about converting between inches and feet, cups and milliliters, pounds and kilograms, and Celsius and Fahrenheit.
You’ll also need to know Roman numerals and military time, both of which come up regularly in healthcare settings. A built-in on-screen calculator is available during this section, but personal calculators are not permitted. The math here is straightforward if you’ve reviewed your conversion tables and basic arithmetic, but the conversions trip up a lot of test-takers who haven’t practiced them recently. Memorizing key equivalencies (1 cup = 240 mL, 1 pint = 473 mL, 1 quart = 946 mL) will save you time on test day.
Reading Comprehension
This section presents short passages followed by questions that test your ability to identify main ideas, draw inferences, and use context clues to figure out unfamiliar words. You’ll need to distinguish between what a passage directly states and what it implies. Questions also cover identifying an author’s tone, purpose, and underlying assumptions.
The passages tend to be health or science-related, but you don’t need prior medical knowledge to answer correctly. Everything you need is contained in the passage itself. The skill being tested is whether you can read dense, technical material carefully and pull accurate conclusions from it, which is exactly what nursing school requires.
Vocabulary and Grammar
The Vocabulary section asks you to identify the correct meaning of words, many of which appear in medical or scientific contexts. Some questions give you a word in isolation, while others place it in a sentence and ask you to determine its meaning from context. Building familiarity with common medical prefixes, suffixes, and root words (like “optic” referring to the eye or vision) makes this section much more manageable.
Grammar covers the building blocks of English sentence structure: parts of speech, sentence types, and common errors. You’ll see questions about adjectives, adverbs, conjunctions, independent and dependent clauses, compound sentences, and subject-verb agreement. If you can identify a dependent clause (one that starts with a subordinating conjunction and can’t stand alone) and know the difference between common homophones, you’re in solid shape. This section rewards careful attention to sentence mechanics rather than creative writing ability.
Biology
The Biology section focuses on foundational concepts you’d encounter in an introductory college course. Cellular biology is a major topic: you should understand the difference between active transport (which requires the cell to spend energy) and passive transport (which doesn’t). Questions also cover cell structure, photosynthesis, cellular respiration, DNA and genetics basics, and biological classification.
With only 25 scored questions, this section is more targeted than a full biology final. Focus your study time on cellular processes, basic genetics, and the characteristics of living organisms.
Chemistry
Chemistry questions cover fundamental principles: the periodic table, atomic structure, chemical bonds, states of matter, acids and bases, and basic chemical reactions. You won’t need to balance complex equations, but you should understand how atoms form bonds, what pH measures, and how energy transfers during reactions. Like Biology, this section runs 25 scored questions and stays at an introductory level.
Anatomy and Physiology
This is often the section nursing applicants spend the most time preparing for, and for good reason. It covers the 11 organ systems of the human body and expects you to know what each one does. You should understand that the cardiovascular system transports oxygen and nutrients to tissues, the lymphatic system includes the spleen, the muscular system produces movement through contraction, the nervous system includes the brain, and the integumentary system (the skin) serves protective and regulatory functions.
Questions also test anatomical terminology. You’ll need to know directional terms like anterior (toward the front of the body) and proximal (close to the trunk). Expect questions about the four basic tissue types and the differences between skeletal, smooth, and cardiac muscle. Knowing that adipose tissue is connective tissue, not muscle tissue, is the kind of distinction this section tests.
Physics
Not all nursing programs require the Physics section, so check your school’s requirements before spending study time here. When included, it covers basic mechanics, energy, waves, and simple electrical concepts. The math stays at an introductory level, and the emphasis is on understanding core principles rather than solving complex equations.
Scoring and Passing Requirements
Each section is scored as a percentage, and your school combines these into a composite score using its own formula. At South Texas College, for example, the English language composite, science composite, and math score are each calculated separately, then averaged together. Their minimum passing threshold is 75% per section, while other schools set the bar at 78% or higher. There’s no universal passing score across all programs, so your target number depends entirely on where you’re applying. Competitive programs may expect scores in the mid-80s or above.
The unscored pilot questions on each section don’t count toward your percentage, but since you can’t identify which ones they are, treat every question as if it matters.
Retakes and Test Day Rules
Most schools allow you to take the HESI A2 twice within one academic year. If you don’t meet the required score after two attempts, you typically have to wait a full year from your first test date before trying again. A minimum of 30 days must pass between attempts. These policies vary by institution, so confirm the rules with your specific program before scheduling.
On test day, you won’t be allowed to bring a personal calculator, phone, or notes into the testing room. The exam provides a built-in on-screen calculator for the math section. Scratch paper policies depend on the testing site, but most provide something for you to work with during the exam. Arrive having memorized your key conversion formulas and vocabulary rather than planning to look anything up.
What Schools Actually Require
Very few programs require all eight academic sections. A typical nursing school might ask for Math, Reading Comprehension, Vocabulary, Grammar, and Anatomy and Physiology, skipping Chemistry and Physics entirely. Some combine the English sections into a single composite score. Before you start studying, pull up the specific HESI requirements from your program’s admissions page. This tells you exactly which sections to prioritize and what score you need, so you don’t waste preparation time on material your school won’t even look at.