HESI A2 in 2026: The Score Your Nursing School Actually Requires
The HESI A2 (Health Education Systems, Inc. Admission Assessment) is a nursing school entrance exam used by hundreds of programs across the United States. But here's what creates the most confusion and anxiety for applicants: every nursing school sets its own score requirements, and the differences are significant.
Some programs accept 75%. Others won't look at you below 90%. Some require composite scores. Others require minimum scores in each individual section. This guide cuts through the confusion and tells you exactly what you need.
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HESI A2 Exam Format & Structure
| Component | Details |
|---|---|
| Sections | Modular — up to 10 (your school selects which ones you take) |
| Questions per Section | 14–55 (scored counts are lower; see breakdown) |
| Time Limit | Set by your school; about 5–5.25 hours if all sections are taken |
| Score Scale | 0–100% per section |
| Passing Score | No universal pass mark — each nursing program sets its own (commonly 75%–80%) |
| Cost | About $35–$100 (set by the school/testing site) |
| Provider | Elsevier (delivered through nursing-school testing centers and Evolve) |
| Retake Policy | Set by individual school (often a 60-day wait; varies widely) |
The HESI A2 Sections (Scored vs. Total Questions)
The HESI A2 is modular: Elsevier offers eight academic subtests plus three non-academic components, and each nursing program chooses which ones applicants must complete. A detail most guides miss — every section mixes in unscored "pilot" questions (usually 5 per section) that look identical to real questions but do not count toward your percentage. The table below shows both the scored questions (what your percentage is based on) and the total questions you will actually see.
| Section | Scored Q | Pilot Q | Total Q | Time | Tested By Most Schools? |
|---|---|---|---|---|---|
| Mathematics | 50 | 5 | 55 | 50 min | Yes — almost universal |
| Reading Comprehension | 47 | 3 | 50 | 60 min | Yes — almost universal |
| Vocabulary & General Knowledge | 50 | 5 | 55 | 50 min | Yes — very common |
| Grammar | 50 | 5 | 55 | 50 min | Yes — very common |
| Anatomy & Physiology | 25 | 5 | 30 | 25 min | Yes — most BSN programs |
| Biology | 25 | 5 | 30 | 25 min | Common |
| Chemistry | 25 | 5 | 30 | 25 min | Some programs |
| Physics | 25 | — | 25 | 50 min | Rare (few programs require) |
| Critical Thinking | 30 | — | 30 | ~30 min | Uncommon (scored separately) |
| Learning Style | — | — | 14 | 15 min | Non-academic; not scored |
| Personality Profile | — | — | 15 | 15 min | Non-academic; not scored |
Important: Your nursing school will tell you which sections to take. Most programs require 4–6 sections. The "core four" (Math, Reading, Vocabulary & General Knowledge, Grammar) are almost universal. Because pilot questions are invisible, treat every question as if it counts.
Score Requirements by Nursing Program Type
Score requirements vary dramatically. Here's a general framework:
Community College / ADN Programs
| Score Level | What It Means |
|---|---|
| 75% composite | Minimum to apply at many ADN programs |
| 80% composite | Competitive for most community college programs |
| 85%+ composite | Strong application; likely admission |
University BSN Programs
| Score Level | What It Means |
|---|---|
| 78–80% composite | Minimum cutoff at many state universities |
| 82–85% composite | Competitive at most BSN programs |
| 88–92%+ composite | Required at highly competitive programs |
Accelerated BSN / Direct-Entry MSN Programs
| Score Level | What It Means |
|---|---|
| 85% composite | Minimum for many ABSN programs |
| 90%+ composite | Competitive at top accelerated programs |
| Individual section minimums | Many require 80%+ per section (no weak areas) |
Key Score Thresholds to Remember
- Below 75%: Very few programs will accept this score
- 75–79%: Meets minimum for many ADN programs; below threshold for most BSN programs
- 80–84%: Competitive for ADN and many BSN programs
- 85–89%: Strong for most BSN programs; competitive for accelerated programs
- 90%+: Competitive everywhere; opens doors to the most selective programs
HESI A2 Sections Ranked by Difficulty
Based on student performance data and failure rates, here's how the sections rank from hardest to easiest:
| Rank | Section | Avg. Score | Why It's Difficult |
|---|---|---|---|
| 1 (Hardest) | Anatomy & Physiology | 65–72% | Vast content, requires deep understanding of body systems |
| 2 | Chemistry | 68–75% | Math-heavy, requires understanding of chemical concepts |
| 3 | Biology | 70–76% | Broad range of topics from cellular to ecological |
| 4 | Mathematics | 75–80% | No calculator on some versions; ratios, fractions, conversions |
| 5 | Grammar | 78–83% | Tricky sentence structure and punctuation rules |
| 6 | Vocabulary | 80–85% | Medical terminology heavy; context clues help |
| 7 (Easiest) | Reading Comprehension | 82–88% | Passage-based; good readers score well naturally |
The A&P Problem
Anatomy & Physiology is where most HESI A2 scores fall apart. The section covers:
- All 11 body systems (cardiovascular, respiratory, nervous, endocrine, etc.)
- Cellular biology (cell structure, mitosis, meiosis)
- Tissue types (epithelial, connective, muscle, nervous)
- Organ functions and interactions
- Homeostasis mechanisms
With only 25 scored questions (30 total, including pilot items), each question covers a different system or concept. There's no room for weakness in any area. The difficulty averages above are widely reported student estimates, not official Elsevier statistics — HESI does not publish national section averages.
Section-by-Section Study Strategy
Mathematics (50 Questions)
What's Tested:
- Fractions, decimals, percentages, ratios
- Dosage calculations and unit conversions
- Roman numerals and military time
- Basic algebra and word problems
- Measurement conversions (metric ↔ household)
High-Yield Study Tips:
- Master dosage calculations: "Desired over Have" method
- Memorize conversions: 1 kg = 2.2 lbs, 1 oz = 30 mL, 1 tsp = 5 mL
- An on-screen calculator is provided in the testing software (personal calculators are not allowed)
- Focus on ratio/proportion — it's the most common question type
Reading Comprehension (47 Questions)
What's Tested:
- Main idea identification
- Supporting details and evidence
- Inference and conclusion drawing
- Author's purpose and tone
- Fact vs. opinion
High-Yield Study Tips:
- Read the questions first, then the passage — know what to look for
- Answers are always in the passage — don't use outside knowledge
- Eliminate extreme language ("always," "never") in answer choices
- Practice with healthcare-themed passages (HESI uses medical topics)
Vocabulary & General Knowledge (50 scored / 55 total Questions)
What's Tested:
- Medical terminology (prefixes, suffixes, roots)
- Context clue usage
- Synonym and antonym identification
- Words commonly used in healthcare settings and general everyday usage
High-Yield Study Tips:
- Learn word parts: hyper- (above), hypo- (below), -itis (inflammation), -ectomy (removal)
- Study the HESI A2 vocabulary list (Elsevier publishes one)
- Use context clues in the sentence to determine meaning
- Focus on healthcare vocabulary over general vocabulary
Grammar (50 Questions)
What's Tested:
- Subject-verb agreement
- Pronoun usage
- Commonly confused words (their/there/they're, affect/effect)
- Sentence structure and punctuation
- Active vs. passive voice
High-Yield Study Tips:
- Most common errors tested: subject-verb agreement, comma splices, run-on sentences
- Learn the commonly confused word pairs — guaranteed to appear
- Read the complete sentence before choosing; look for what "sounds right"
- Independent vs. dependent clauses — know when to use semicolons vs. commas
Anatomy & Physiology (25 scored / 30 total Questions)
What's Tested:
- All 11 organ systems and their functions
- Cellular structure and processes
- Tissue types and locations
- Electrolyte balance and homeostasis
- Anatomical terminology and body planes
High-Yield Study Tips:
- Focus on cardiovascular and respiratory first — most commonly tested
- Know the path of blood through the heart (right atrium → right ventricle → pulmonary artery → lungs → pulmonary veins → left atrium → left ventricle → aorta)
- Understand hormones and their glands (insulin/pancreas, thyroxine/thyroid, cortisol/adrenal)
- Study nerve impulse transmission and neurotransmitters
- Use diagrams and labeling exercises — visual learning sticks for A&P
Free HESI A2 Practice Questions
Our question bank covers all HESI A2 sections with detailed explanations for every answer choice.
4-Week HESI A2 Study Plan
This schedule is weighted toward the hardest sections:
| Week | Focus | Daily Study (90 min) | Activities |
|---|---|---|---|
| Week 1 | A&P + Biology | 90 min | Body systems (2 per day), cellular biology, diagrams |
| Week 2 | Math + Chemistry | 90 min | Dosage calculations, conversions, ratio/proportion, basic chem |
| Week 3 | Vocabulary + Grammar | 90 min | Medical terminology word parts, grammar rules, practice drills |
| Week 4 | Reading + Full Practice Tests | 90 min | Timed passage reading, full practice tests, review weak areas |
Total study time: 40–50 hours over 4 weeks
Study Priority Breakdown
| Section | Study Time Allocation | Why |
|---|---|---|
| A&P | 30% | Hardest section, lowest average scores |
| Math | 20% | Requires practice, no shortcuts |
| Vocabulary | 15% | Medical terminology takes repetition |
| Grammar | 15% | Rule-based, quick to improve |
| Reading | 10% | Most intuitive; practice improves speed |
| Biology/Chemistry | 10% | If required by your program |
HESI A2 Retake Policies
Retake policies are set by individual schools, but common patterns:
| Policy | Typical Rule |
|---|---|
| Wait period | 60–90 days between attempts |
| Maximum attempts | 2–3 per year |
| Score validity | 1–2 years (varies by school) |
| Best score used? | Some schools use highest, others use most recent |
| Cost per retake | ~$35–$100 |
Important: Some schools will only accept your FIRST attempt score. Check with your specific program before relying on a retake strategy.
Exam Day Tips
Before the Exam
- Check which sections your school requires — don't study for Physics if it's not required
- Get the testing location details from your nursing program (usually on-campus)
- Bring a government-issued photo ID
- Get a full night's sleep — A&P recall is heavily impacted by fatigue
During the Exam
- Section timing varies — keep an eye on the clock for each section
- You can't go back to previous sections once you submit
- Use process of elimination — cross off obviously wrong answers first
- Don't overthink vocabulary questions — your first instinct on word meaning is often correct
- For math: Use the on-screen calculator provided, write down your work, check units
Score Results
- Unofficial scores may be available immediately after testing
- Official scores are sent to your nursing program within 24–48 hours
- You receive a score for each section — check which sections matter for your application
HESI A2 vs. TEAS: Quick Comparison
Many nursing schools accept either the HESI A2 or the TEAS. Key differences:
| Feature | HESI A2 | TEAS |
|---|---|---|
| Provider | Elsevier | ATI |
| Sections | Modular — up to 10 (school selects) | 4 fixed sections |
| Total Questions | Varies by sections chosen (often 200–350) | 170 scored |
| Time | ~5–5.25 hours if all sections taken | ~3.5 hours (209 min) |
| Scoring | Percentage per section | Composite + section scores |
| Harder Section | A&P | Science |
| Cost | ~$35–$100 | ~$70–$115 |
If your school accepts both, check which exam aligns better with your strengths. Students strong in A&P often prefer the HESI.
Your Nursing Career Starts Here
Join thousands of nursing school applicants using our comprehensive, 100% FREE HESI A2 prep materials:
- All sections covered — Math, Reading, Vocabulary, Grammar, A&P, Biology, Chemistry
- Section-specific practice questions with detailed explanations
- AI-powered study help — get instant explanations for any concept
- Updated for 2026 content and question styles
No credit card required. Your nursing school acceptance starts with a strong HESI score.
Official Resources
- Elsevier HESI A2 Information — Official exam provider
- NLN (National League for Nursing) — Nursing education standards
- AACN (American Association of Colleges of Nursing) — BSN program information
- BLS Registered Nurses Career Outlook — Nursing career data
- Your nursing school's admissions page — For specific HESI requirements
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