Understanding the HESI Exam: What Pre-Nursing Students Need to Know

If you're applying to nursing school, you've likely encountered an alphabet soup of entry exams: TEAS, HESI, ATI, NLN… It's overwhelming, and the stakes are real because your entrance exam score can determine whether you get a seat in a competitive cohort. The HESI A2 (Health Education Systems, Inc. Admission Assessment) is one of the two dominant admission exams in U.S. nursing education—used by hundreds of programs, from ADN to BSN—and it is designed to answer one question: Is this applicant academically ready for the rigor of a nursing curriculum?

Understanding the HESI before you register is half the battle, because the exam's structure is genuinely confusing at first: it's not one fixed test but a menu of subtests that each school picks from. Here is everything pre-nursing students need to know, from structure and scoring to strategic preparation.

What the HESI A2 Is (and Isn't)

The HESI A2 is published by Elsevier (the same company behind many nursing textbooks) and is administered mostly on computer at testing centers or proctored online. It evaluates the academic foundations nursing students need most: reading comprehension, vocabulary, grammar, mathematics, and core sciences.

Three things to internalize immediately:

• It is not one universal exam. Each nursing program selects which subtests to require and sets its own passing scores. Your friend's HESI at school A may not even include chemistry; yours at school B might.
• It is not the HESI exit exam. The HESI Exit Exam (often just called "HESI") is taken during nursing school to predict NCLEX readiness. The A2 is the pre-admission version. Confusing the two wastes research time—make sure any program you contact is discussing the A2.
• Your score is school-specific. There is no national "pass," there are program cutoffs. One school may require 75% on Anatomy & Physiology; another may build a weighted composite where A&P counts double.

The Subtest Menu: What's on the A2

The HESI A2's most commonly required subtests and their typical question counts:

Subtest	Typical Questions	What It Tests
Anatomy & Physiology	25	Body systems, organ functions, medical terminology foundations
Biology	25	Cells, cellular respiration, basic genetics, biological molecules
Chemistry	25	Atomic structure, bonding, solutions, basic reactions
Reading Comprehension	50	Main idea, supporting details, inference, author's purpose
Vocabulary & General Knowledge	50	Healthcare-related vocabulary, word meanings in context
Grammar	50	Parts of speech, sentence structure, punctuation, common errors
Mathematics	50	Basic operations, fractions/decimals/percents, ratios, conversions, word problems
Physics (less common, optional)	25	Basic mechanics, energy, electricity

Some programs also add a Critical Thinking component (typically scenario-based reasoning, not a scored subtest at every school). Total questions across all subtests can reach roughly 275, but again—only the subtests your school requires will appear in your test.

The most common required combination across programs is: Anatomy & Physiology, Reading Comprehension, Vocabulary, Grammar, and Math. Science-heavy programs (many BSN programs) add Biology and Chemistry.

How the HESI A2 Is Scored

Each subtest is scored on a 0–100 scale (percentage correct). Schools then interpret those scores through their own filters:

• Many programs require a minimum score per subtest (commonly 75–80 in A&P, 70–80 in the others).
• Many also compute a composite score (often the average of required subtests, sometimes weighted—A&P and Reading may count double).
• Retake policies vary: some schools limit to 2 attempts, some cap attempts per year, and some require a waiting period or remediation course before retaking. Ask for each school's retake policy in writing—it directly affects how many times you can afford to sit for the exam.

The subtle strategic implication: when a school weights A&P double, a mediocre A&P score drags you down twice as hard. Know the weighting before you allocate study time.

What Pre-Nursing Students Get Wrong About the HESI

1. "I'll just take whatever subtest they mention at orientation." Wrong: the subtest menu varies, and you need the official list from your target program's admissions page months ahead. If Biology is required and you studied only A&P, you've lost a long shot at one application cycle.
2. "The TEAS prep I already did covers it." The TEAS and HESI overlap (both test reading, math, and science) but are different exams by different publishers with different item styles and different emphases. HESI vocabulary is more healthcare-heavy; HESI A&P goes deeper into organ-system detail; HESI chemistry appears as a subtest in versions where TEAS keeps chemistry folded into general science. Use HESI-specific materials—do not assume transferability.
3. "Scoring 80 on Reading means I'm ready." Nursing programs frequently find that reading comprehension predicts clinical success, and they may weight it accordingly. Additionally, nursing school reading loads are enormous; the HESI Reading subtest is a proxy for whether you can handle them.
4. "I can retake freely until I pass." As noted, many programs cap attempts. Treat every sitting as precious—walk in only when practice scores exceed your target by a margin.

How to Prepare Effectively (A Strategic Plan)

Step 1: Lock down your target program's requirements (Week 1)

Get the exact list of required subtests, the minimum score per subtest, composite formula, retake policy, and test format (computer at their testing center vs. online proctored). Write them into a one-page summary. This page is now your study contract.

Step 2: Take a baseline HESI A2 practice test (Week 1–2)

Use official Elsevier HESI A2 practice materials (practice tests, question banks, and the HESI Admission Assessment Exam Review book). Take a full practice test of only your required subtests, timed. Record per-subtest scores. Your gap list = required subtests where you scored below your target.

Step 3: Weighted study allocation (Weeks 2–6)

Allocate time by program weighting × your weakness:

• Anatomy & Physiology (usually the priority): master the organ systems the same way you'll meet them in nursing: cardiovascular (blood flow, heart anatomy, major vessels), respiratory (gas exchange, lung anatomy), renal (filtration, fluid balance), digestive, nervous, endocrine. Learn terminology with medical roots. Flashcards with "what happens when X malfunctions" phrasing mirror how nursing asks about the body.
• Reading Comprehension: practice the same passage→question technique used on the TEAS: read questions first, identify main idea vs. supporting detail, watch for inference traps. 50 questions means pacing is critical—about 1 minute per question.
• Vocabulary & General Knowledge: this is the most memorizable section. Build a deck of the ~100 most common healthcare terms (medical, surgical, chronic, acute, prognosis, diagnosis, contraindication…) plus word roots (cardi-, neuro-, gastro-, hemo-, -itis, -ectomy). Context clues cover the rest.
• Grammar: drill subject–verb agreement, pronouns, commas, and sentence fragments—the same high-yield rules tested on the TEAS.
• Mathematics: conversions, fractions/decimals/percents, ratios (especially drug-dosage-style ratios if the program requires them), and word problems.
• Biology/Chemistry (if required): cells and cellular processes first (biology), then atomic structure, bonding, and solutions basics (chemistry). Depth equals the A&P subtest roughly; breadth is limited to first-semester college intro-level content.

Step 4: Structured practice (Weeks 6–8)

Take at least one more full official practice test per week for your required subtests, timed and in one sitting where possible. After each, write every missed concept into your gap list and study only those. Two weeks before exam day, you should be scoring 5–10 points above your program cutoff on every required subtest.

Step 5: Logistics and test-day execution

• Confirm your appointment time, location (or proctoring software), and required ID weeks ahead; run any system checks early.
• Sleep eight hours the night before; the HESI is an endurance event, not a sprint.
• Pace: ~1 minute per question on the 50-question subtests (they're typically allotted around 50–60 minutes each), a bit faster on the 25-question science subtests.
• Answer everything; verify whether your program's version penalizes blanks (most do not).
• Bring what your testing center allows (ID, approved calculator policy—usually an on-screen calculator is provided for math).

The Final Word: The HESI Is an Invitation to Prepare Like a Nurse

Here's the mindset shift that pays off: the HESI A2 doesn't just filter applicants—it previews what nursing school will demand. The vocabulary you drill is the vocabulary of charts and prescriptions. The A&P you memorize is the body you'll assess at the bedside. The reading stamina you build is the stamina for nursing textbooks and shift notes. Prepare for the HESI like it's your first nursing course, and you're not just earning an admission score—you're building the foundation your program will build on.

Your call to action: this week, pull your target program's admissions page and write down the exact HESI subtests, cutoffs, and retake policy. Next week, take the official Elsevier practice test for those subtests. That baseline score is your real starting line—everything before it was just planning.