Written by Anna Curran, RN, BSN, PHN — former ADN and BSN clinical nursing instructor. Updated July 2026.
The HESI A2 is the entrance exam that stands between you and nursing school. The confusing part is that no two schools give the same test. Your program picks which sections you take and sets its own passing score, which is why every website you visit gives you a different number of questions.
This page gives you the official exam structure straight from Elsevier, the high-yield vocabulary list, an anatomy and physiology review, and free practice tests. No email required.
What is on the HESI A2 exam
The HESI A2 — also called the Evolve Reach Admission Assessment — is a computer-based multiple choice exam. Elsevier offers these sections, and your program chooses which ones you sit for.
| Section | Items | Recommended time |
|---|---|---|
| Reading Comprehension | 55 | 60 minutes |
| Vocabulary and General Knowledge | 55 | 50 minutes |
| Grammar | 55 | 50 minutes |
| Math | 55 | 50 minutes |
| Anatomy and Physiology | 30 | 25 minutes |
| Biology | 30 | 25 minutes |
| Chemistry | 30 | 25 minutes |
| Learning Style | 14 | 15 minutes |
| Personality Style | 15 | 15 minutes |
Source: HESI Admission Assessment (A2) Faculty Scoring Guide, Elsevier. Some programs also offer Physics and Critical Thinking.
Why the question counts online never match. Elsevier builds each section with pilot items mixed in. A 55-item section has 50 scored questions and 5 unscored trial questions; a 30-item section has 25 scored and 5 trial. Both numbers are correct — one counts everything you see, the other counts only what affects your score. You cannot tell which is which while testing, so answer every question as if it counts.
What score do you need to pass?
There is no national passing score. Each program sets its own, and most require 75% to 80%, often on every section individually rather than on your average. Competitive programs want 85% and up.
Two real examples: South Texas College requires 75% or higher on each section for its ADN program, and Tarrant County College allows 5 hours and lets each program decide which sections apply.
Before you study anything else, email your nursing program and ask two questions: which sections am I required to take, and what is the minimum score on each? Everything about your study plan depends on those answers.
HESI A2 vocabulary list
Vocabulary is the section students skip because it feels impossible to study. It is not. The word pool is finite and it repeats, and it leans heavily on words you will hear on a hospital floor. Learn this list and you bank an easy score.
These are the terms I saw come up most often with my own students.
Terms that describe a patient’s condition
| Word | What it means | In context |
|---|---|---|
| Abstain | To hold back or refrain from | The patient must abstain from food before surgery. |
| Acute | Sudden onset, severe, short duration | She was admitted with acute chest pain. |
| Chronic | Long-lasting, persistent | He has chronic back pain from an old injury. |
| Cyanotic | Bluish discoloration from low oxygen | The infant’s lips appeared cyanotic. |
| Distended | Swollen, stretched, enlarged | The abdomen was distended and firm. |
| Flushed | Reddened, warm skin | Her face was flushed and she felt hot. |
| Labored | Difficult, requiring effort | The patient had labored breathing. |
| Lethargic | Drowsy, sluggish, low energy | The child became lethargic after the fever. |
| Malaise | A general feeling of being unwell | He reported fatigue and malaise for three days. |
| Pallor | Unusual paleness of the skin | Pallor may indicate anemia or blood loss. |
| Symptom | What the patient reports feeling | Nausea is a symptom, not a sign. |
| Syndrome | A group of signs and symptoms occurring together | The patient was diagnosed with compartment syndrome. |
| Lesion | An area of damaged or abnormal tissue | A lesion was noted on the left forearm. |
| Edema | Swelling from fluid buildup in tissue | Pitting edema was present in both ankles. |
| Vertigo | A spinning sensation | She reported vertigo when standing up. |
Terms used in care and treatment
| Word | What it means | In context |
|---|---|---|
| Ambulate | To walk | Encourage the patient to ambulate twice a day. |
| Aspirate | To inhale fluid into the airway; or to withdraw by suction | Position the patient upright so she does not aspirate. |
| Compress | To press together; a cloth pad applied to the body | Apply a cold compress to reduce swelling. |
| Contraindication | A reason not to give a treatment | Pregnancy is a contraindication for this drug. |
| Dilate | To widen or enlarge | The pupils dilate in dim light. |
| Excrete | To eliminate waste from the body | The kidneys excrete urea in urine. |
| Hydration | The amount of fluid in the body | Assess hydration by checking skin turgor. |
| Ingest | To take in by mouth | Do not ingest anything after midnight. |
| Palpate | To examine by touch | Palpate the abdomen for tenderness. |
| Paramount | Most important, above all others | Airway management is paramount. |
| Potent | Strong, powerful in effect | This is a potent medication — verify the dose. |
| Restrict | To limit | Restrict fluids to 1,500 mL per day. |
| Suture | A stitch used to close a wound | The sutures will be removed in ten days. |
| Therapeutic | Healing; having a beneficial effect | The drug reached a therapeutic level. |
| Void | To urinate | Ask the patient to void before the procedure. |
Terms that tell you how, when, or where
| Word | What it means | In context |
|---|---|---|
| Adhere | To stick to; to follow closely | Adhere to the medication schedule exactly. |
| Bilateral | Affecting both sides | Bilateral breath sounds were clear. |
| Deficit | A shortage or lack | A fluid volume deficit was documented. |
| Depress | To press down; to lower | This drug can depress respirations. |
| Deteriorate | To get worse | His condition began to deteriorate overnight. |
| Discrete | Separate and distinct | Three discrete nodules were palpated. |
| Exacerbate | To make worse | Cold air can exacerbate asthma. |
| Gaping | Wide open | The wound edges were gaping. |
| Impaired | Weakened, damaged, functioning poorly | The patient has impaired mobility. |
| Intact | Whole, undamaged | Skin is intact with no breakdown. |
| Lateral | Toward the side | Turn the patient to a lateral position. |
| Occluded | Blocked or closed off | The IV line was occluded. |
| Overt | Obvious, out in the open | There were no overt signs of bleeding. |
| Patent | Open and unobstructed | Confirm the airway is patent. |
| Posterior | Toward the back | A pressure ulcer formed on the posterior heel. |
| Prognosis | The expected outcome of an illness | The prognosis is good with early treatment. |
| Proximal | Nearer to the center of the body | The wound is proximal to the elbow. |
| Distal | Farther from the center of the body | Check distal pulses in the foot. |
| Recur | To happen again | The infection may recur without full treatment. |
| Supine | Lying flat on the back | Place the patient in a supine position. |
| Prone | Lying flat on the stomach | Prone positioning can improve oxygenation. |
| Transient | Temporary, short-lived | The dizziness was transient and resolved. |
| Untoward | Unfavorable, unexpected, harmful | Monitor for any untoward reaction. |
| Virulent | Extremely infectious or harmful | This is a virulent strain of the virus. |
General academic words that still show up
| Word | What it means | In context |
|---|---|---|
| Ambiguous | Unclear, open to more than one meaning | The instructions were ambiguous. |
| Comply | To follow a rule or request | The patient did not comply with the diet. |
| Consistency | Thickness or texture; being steady over time | Note the consistency of the drainage. |
| Depict | To show or represent | The diagram depicts blood flow through the heart. |
| Deficient | Lacking something needed | Her diet was deficient in iron. |
| Devoid | Completely lacking | The chart was devoid of any allergy history. |
| Discrepancy | A difference between two things that should match | There was a discrepancy in the narcotic count. |
| Elevate | To raise | Elevate the affected limb above heart level. |
| Endogenous | Originating from inside the body | Cortisol is an endogenous hormone. |
| Exogenous | Originating from outside the body | Exogenous insulin is given by injection. |
| Initiate | To begin | Initiate CPR immediately. |
| Insidious | Developing gradually and harmfully | The onset of symptoms was insidious. |
| Precipitous | Very rapid, sudden, steep | She had a precipitous delivery. |
| Preexisting | Present before | He has a preexisting heart condition. |
| Rationale | The reason behind a decision | Document the rationale for the intervention. |
| Sufficient | Enough | Ensure sufficient fluid intake. |
HESI A2 anatomy and physiology review
A&P is 30 items in 25 minutes — about 50 seconds per question. It is a recall section, not a reasoning section, which makes it the most predictable part of the whole exam and the best use of your study time.
Directional terms you must know cold
- Anterior / Posterior — front / back
- Superior / Inferior — above / below
- Medial / Lateral — toward the midline / away from the midline
- Proximal / Distal — closer to the trunk / farther from the trunk
- Superficial / Deep — near the surface / farther inside
- Supine / Prone — on the back / on the stomach
The systems that get tested most
Cardiovascular. Know the path of blood: body to vena cava to right atrium, through the tricuspid valve to the right ventricle, through the pulmonic valve to the lungs, back via pulmonary veins to the left atrium, through the mitral valve to the left ventricle, out the aortic valve to the body. The left ventricle is the thickest chamber because it pumps to the entire body. Arteries carry blood away from the heart; veins carry it back.
Respiratory. Air travels nose to pharynx to larynx to trachea to bronchi to bronchioles to alveoli. Gas exchange happens in the alveoli. The diaphragm contracts and moves down to create inspiration. The right lung has three lobes; the left has two, because the heart takes up the space.
Renal. The nephron is the functional unit of the kidney. Filtration happens at the glomerulus. Kidneys regulate fluid balance, electrolytes, blood pressure, and pH, and they produce erythropoietin, which triggers red blood cell production. Urine path: kidney to ureter to bladder to urethra.
Skeletal. The adult skeleton has 206 bones, divided into axial (skull, spine, ribs, sternum) and appendicular (limbs and girdles). Red bone marrow makes blood cells. The femur is the longest and strongest bone.
Muscular. Three types: skeletal (voluntary, striated), cardiac (involuntary, striated, only in the heart), and smooth (involuntary, non-striated, in organs and vessels).
Nervous. Central nervous system is the brain and spinal cord; peripheral is everything else. The neuron is the basic unit. The cerebellum handles balance and coordination; the medulla controls heart rate and breathing; the cerebrum handles thought and voluntary movement.
Endocrine. The pituitary is the master gland. Thyroid controls metabolism. Adrenal glands sit on top of the kidneys and release cortisol and epinephrine. The pancreas releases insulin, which lowers blood glucose, and glucagon, which raises it.
Digestive. Mouth to esophagus to stomach to small intestine to large intestine to rectum. Most nutrient absorption happens in the small intestine. The large intestine absorbs water.
Integumentary. Skin layers from outside in: epidermis, dermis, hypodermis (subcutaneous). Functions are protection, temperature regulation, sensation, and vitamin D synthesis.
Free HESI A2 practice tests
Watch these and answer out loud before I give the answer. Passive watching does not build recall.
- HESI A2 Vocabulary Practice Test 2025 & 2026
- HESI A2 Vocabulary — 25 Questions, Test 1
- HESI A2 Anatomy and Physiology — 25 Questions, Test 1
A four-week HESI A2 study plan
Week 1. Confirm with your program which sections you need and what score you must hit. Take one practice test per required section to find your weakest area. Do not study yet — find out where you actually stand first.
Week 2. Attack your weakest section only. For most students this is math or A&P. Work it daily. Leave your strong sections alone this week.
Week 3. Add vocabulary. Fifteen words a day, reviewed the next morning. This is the highest return per minute of any section because the list is finite.
Week 4. Full-length timed practice under real conditions — no phone, no pausing, no notes. Review every question you missed and write down why you missed it. Rest the day before your exam.
The mistake I saw most often as an instructor. Students studied the section they liked best and avoided the one they feared. The HESI A2 is frequently scored section by section, so one weak section can sink an otherwise strong application. Study what scares you.
Common questions
How many times can I take the HESI A2? Your school decides. Many programs allow up to three attempts per year with a waiting period between them. Confirm your program’s policy before you sit the first time.
Is a calculator allowed? An on-screen calculator is provided for the math section.
Is the HESI A2 harder than the NCLEX? No, and they test completely different things. The HESI A2 tests whether you have the academic foundation to start nursing school. The NCLEX tests whether you can think like a safe nurse. If you are studying for both, do not use the same materials.
Do the Learning Style and Personality sections affect my score? No. They generate a study-tips printout and do not count toward admission.
Keep going
- Free NCLEX practice test — for when you are already in nursing school
- More free nursing study guides and care plans
HESI® and Evolve Reach® are registered trademarks of Elsevier Inc. NurseStudy.Net is not affiliated with, endorsed by, or sponsored by Elsevier. This page is independent study material. Always confirm section requirements and passing scores with your own nursing program.