Executive Summary: What is the HESI A2 Exam?
The HESI A2 (Health Education Systems, Inc. Admission Assessment) is a computer-adaptive entrance examination produced by Elsevier Inc. and administered via Evolve Reach and Prometric Testing Centers. Used by nursing schools and allied health programs across the United States, the exam measures academic readiness across up to 8 subject areas comprising 326 questions with a strict 4-hour (240 minutes) cumulative time limit.
HESI A2 Core Exam Specifications
- Testing Authority: Elsevier Inc. / Evolve Reach / Prometric / On-Campus Testing Services
- Question Volume: 326 Total Questions across 8 Academic Subtests + 2 Personality/Learning Style Modules
- Total Time Allowed: 4 Hours (240 Minutes) self-paced across chosen modules
- Target Passing Score: 75% – 80% Minimum Composite (85%+ for Competitive BSN Cohorts)
- Retake Policy: Maximum of 3 attempts per calendar year with a mandatory 60-day waiting period between tests
- On-Screen Calculator: Permitted ONLY during the Mathematics subtest
HESI A2 vs. ATI TEAS 7: Key Differences for Nursing Applicants
The two most common nursing entrance examinations across the United States are the HESI A2 (Elsevier) and the ATI TEAS 7 (Assessment Technologies Institute). Understanding the differences between these two assessments is crucial because nursing schools rarely accept scores interchangeably:
| Examination Feature | HESI A2 (Elsevier Evolve) | ATI TEAS 7 (Assessment Technologies) | Key Preparation Takeaway |
|---|---|---|---|
| Core Subject Modules | Up to 8 Modular Subtests (Math, A&P, Reading, Vocab, Grammar, Bio, Chem, Physics) | 4 Fixed Mandatory Sections (Reading, Mathematics, Science, English & Language Usage) | HESI allows schools to omit subjects (e.g., Physics); TEAS requires every section for all students. |
| Total Question Count | Up to 326 questions (varies by school choice) | 170 total questions (150 scored, 20 unscored pretest) | HESI presents more total items, but gives substantially more time per subject. |
| Time Allotment | 4 Hours (240 minutes) cumulative self-paced | 209 minutes with strict section-by-section timers | HESI allows flexible self-pacing across sections; TEAS cuts you off when section time expires. |
| Science Focus | Heavily emphasizes human Anatomy & Physiology (25 items) | Broader General Science (A&P, General Biology, Chemistry, Scientific Method) | Prioritize memorizing organ systems and cellular biology over theoretical physics. |
| Calculator Policy | Digital on-screen 4-function basic calculator allowed on Math | Digital on-screen 4-function basic calculator provided | Both exams forbid handheld physical calculators at testing centers. |
| Average Passing Target | 75% – 80% composite (85%+ for competitive BSN) | 65% – 70% composite (National Mean ~66%) | HESI requires higher percentage scores due to focused subtest grading scales. |
The 8 HESI A2 Subtests Breakdown & Scoring Matrix
Nursing programs select specific subtests depending on their curriculum focus. Below is the complete breakdown including question volume, time limits, and the percentage of US nursing schools requiring each section:
| Subtest Name | Questions | Time Limit | School Requirement % | Core Content Tested |
|---|---|---|---|---|
| Mathematics | 55 (50 scored) | 50 mins | 98% | Fractions, decimals, ratios, proportions, household-to-metric conversions, Roman numerals, basic algebra |
| Reading Comprehension | 55 (50 scored) | 60 mins | 98% | Main idea identification, context clues, logical inferences, author purpose and tone, passage details |
| Vocabulary & General Knowledge | 55 (50 scored) | 50 mins | 95% | Health-related terminology, medical prefixes/suffixes, general vocabulary used in clinical contexts |
| Grammar | 55 (50 scored) | 50 mins | 92% | Parts of speech, subject-verb agreement, dangling modifiers, sentence structure, commonly confused words |
| Anatomy & Physiology (A&P) | 30 (25 scored) | 25 mins | 88% | Anatomical directions, planes, 11 body systems (cardiovascular, nervous, endocrine, renal, etc.), histology |
| Biology | 30 (25 scored) | 25 mins | 45% | Cellular respiration (ATP), photosynthesis, mitosis vs meiosis, genetics (Punnett squares), DNA/RNA synthesis |
| Chemistry | 30 (25 scored) | 25 mins | 25% | Periodic table, atomic structure, chemical bonding, stoichiometry, acid-base pH scale, solutions |
| Physics | 30 (25 scored) | 25 mins | 12% | Newton's laws of motion, kinematics, friction, thermodynamics, optics, wave mechanics |
HESI A2 Math Study Guide & High-Yield Formulas
The Mathematics section emphasizes rapid mental calculations, conversion ratios, and dosage-style word problems. Below are the essential formulas and conversion tables you must memorize:
Must-Know Unit Conversion Cheat Sheet
| Household Measurement | Metric Equivalent | Clinical Dosage Application |
|---|---|---|
| 1 Teaspoon (tsp) | 5 Milliliters (mL) | Pediatric oral liquid medication doses |
| 1 Tablespoon (tbsp) | 15 Milliliters (mL) / 3 tsp | Standard adult liquid dosage conversion |
| 1 Fluid Ounce (fl oz) | 30 Milliliters (mL) / 2 tbsp | Patient intake & output (I&O) tracking |
| 1 Cup | 8 fl oz / 240 Milliliters (mL) | Dietary fluid balance documentation |
| 1 Pint (pt) | 16 fl oz / 480 Milliliters (mL) | Blood donation and fluid replacement |
| 1 Quart (qt) | 32 fl oz / 2 pints / ~960 mL | Irrigation solution preparation |
| 1 Pound (lb) | 0.453 Kilograms (kg) | Weight conversions (Multiply kg by 2.2 for lbs) |
5 High-Yield Sample Math Questions with Explanations
Q1: Convert 2.5 fluid ounces to milliliters.
Solution: 2.5 fl oz × 30 mL/fl oz = 75 mL.
Q2: Solve for x: 3/4 : 12 :: 5/8 : x
Solution: Product of means = Product of extremes. (12 × 5/8) = (3/4 × x) → 7.5 = 0.75x → x = 10.
Q3: A patient is prescribed 0.5 grams of Amoxicillin. Available tablets are 250 mg each. How many tablets should be administered?
Solution: Convert grams to mg: 0.5 g = 500 mg. 500 mg ÷ 250 mg/tablet = 2 tablets.
Q4: Convert Roman Numeral CXLIV to Arabic numerals.
Solution: C = 100, XL = 40, IV = 4. 100 + 40 + 4 = 144.
Q5: What is 15% of 240?
Solution: 0.15 × 240 = 36.
Anatomy & Physiology (A&P) High-Yield Review
Anatomy & Physiology represents the single highest-yield section for nursing admission boards. Focus your study on anatomical directions, body planes, and major organ systems.
Anatomical Directional Terminology
| Directional Term | Definition | Anatomical Example |
|---|---|---|
| Anterior (Ventral) | Toward the front of the body | The sternum is anterior to the heart |
| Posterior (Dorsal) | Toward the back of the body | The spine is posterior to the esophagus |
| Superior (Cranial) | Above or higher than another structure | The head is superior to the chest |
| Inferior (Caudal) | Below or lower than another structure | The stomach is inferior to the lungs |
| Medial | Toward the midline of the body | The nose is medial to the eyes |
| Lateral | Away from the midline of the body | The ears are lateral to the nose |
| Proximal | Closer to the point of attachment or trunk | The elbow is proximal to the wrist |
| Distal | Farther from the point of attachment or trunk | The fingers are distal to the wrist |
Reading Comprehension & Vocabulary Strategy
The Reading Comprehension and Vocabulary modules test your ability to extract critical clinical facts quickly from passage excerpts.
- Main Idea: Usually found in the first or last paragraph of healthcare passages. Ask yourself: What overarching argument is the author conveying?
- Context Clues: Identify surrounding words to decipher unfamiliar medical terminology. Look for restatements, antonyms, or example lists in adjacent sentences.
- Author Tone: Distinguish between objective scientific writing (neutral/informative) and clinical opinion (persuasive/critical).
50 Essential Medical Root Words, Prefixes & Suffixes
| Root / Prefix / Suffix | Meaning | Clinical Example Term |
|---|---|---|
| Cardio- | Heart | Cardiomegaly (enlarged heart) |
| Nephro- / Reno- | Kidney | Nephritis (kidney inflammation) |
| Hepato- | Liver | Hepatitis (liver inflammation) |
| Pneumo- / Pulmo- | Lungs / Air | Pneumonia (lung tissue infection) |
| Myo- | Muscle | Myocardium (heart muscle wall) |
| -itis | Inflammation | Appendicitis (appendix inflammation) |
| -emia | Blood condition | Anemia (deficiency of red blood cells) |
| -ology | Study of | Pathology (study of disease) |
Grammar & English Usage Guide
The Grammar section evaluates standard written English conventions commonly tested on nursing reports and patient charts:
- Affect vs. Effect: Affect is a verb (Action); Effect is a noun (Result). Example: The medication will affect her fever; the side effect was mild.
- Subject-Verb Agreement: Singular subjects take singular verbs. Watch for prepositional phrases separating subject and verb: "The list of dosage calculations is (not are) long."
- Dangling Modifiers: Ensure descriptive phrases clearly attach to the correct subject. Incorrect: Walking down the hallway, the IV bag fell. Correct: While the nurse was walking down the hallway, the IV bag fell.
Biology & Chemistry Crash Course
Cellular Biology & Genetics
Key topics include Cellular Respiration (Glycolysis, Krebs Cycle, Electron Transport Chain producing 36-38 ATP), Mitosis (somatic cell division into 2 identical diploid daughter cells), Meiosis (gamete division into 4 unique haploid cells), and Punnett Squares for monohybrid genetic crosses.
Chemistry & Solutions
Focus on reading the Periodic Table (atomic mass, valence electrons), balancing chemical equations, understanding molarity (moles per liter), and mastering the pH scale (0-6 Acidic, 7 Neutral, 8-14 Basic/Alkaline).
Physics Essentials
If your target nursing program requires the Physics module, focus on Newton's 3 Laws of Motion, kinetic vs potential energy formulas ($E_k = rac{1}{2}mv^2$), friction coefficients, and basic wave optics ($v = f \lambda$).
6-Week HESI A2 Study Plan & Schedule
- Week 1: Baseline Diagnostic & Math Fundamentals – Take a full practice diagnostic test. Review fractions, ratios, proportions, and unit conversion tables.
- Week 2: Anatomy & Physiology Deep-Dive (Part 1) – Study Cardiovascular, Respiratory, Digestive, and Renal systems. Memorize directional terms.
- Week 3: Anatomy & Physiology Deep-Dive (Part 2) – Master Skeletal, Muscular, Nervous, Endocrine, and Reproductive systems.
- Week 4: Biology & Chemistry Review – Cover ATP cellular respiration, Punnett squares, periodic table trends, and pH buffer systems.
- Week 5: Reading, Vocabulary & Grammar Practice – Drill 50 medical root words, context clue passages, and subject-verb agreement rules.
- Week 6: Full Timed Practice Exams & Final Drill – Complete 2 full-length simulated 4-hour HESI A2 practice tests under strict exam conditions.
Download Free Printable HESI A2 Study Guide PDF
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Download HESI A2 Master Study Guide PDF (2026-2027)
Includes printable conversion cheat sheets, medical root flashcards, A&P directional diagrams, and 50 practice math problems.
