If you're heading into nursing school, you've almost certainly heard of the HESI exam. It's one of the most widely used pre-admission assessments in the United States — and for good reason. Nursing programs need to know that incoming students have the foundational skills to handle a rigorous health sciences curriculum. But here's what a lot of test-takers don't realize right away: the HESI isn't a single fixed test. It's a modular exam, and the sections you'll be required to take depend entirely on the school you're applying to.
That makes preparation a little more nuanced than studying for an exam with a locked-in format. You need to know which sections your target program requires, understand how scoring works, and build a study plan that covers your weak spots without burning out on sections you won't even be tested on. This guide walks through every HESI subject area, explains the scoring system, and gives you section-by-section study strategies — plus free practice tests you can use right now.
One thing that catches many students off guard: two test-takers applying to different nursing schools might walk out of the same testing center having taken completely different combinations of HESI sections. One needed math, reading, vocabulary, and grammar. The other needed math, A&P, biology, and chemistry. Both passed with 80+. Both are now nursing students. The point — what you study should match exactly what your program requires, nothing more, nothing less.
HESI stands for Health Education Systems, Inc. — the company that originally developed the exam. Today it's published by Elsevier, and it's formally known as the HESI Admission Assessment (A2). Nursing schools use it to evaluate whether applicants have the academic skills needed to succeed in a demanding health sciences curriculum.
Unlike some entrance exams that are purely academic in scope, the HESI is designed with nursing in mind. The subjects it covers — anatomy, chemistry, physics, reading comprehension — are all directly relevant to what you'll study. Schools get to choose which sections they require, which means one program might ask for math, reading, vocabulary, and grammar, while another adds A&P, biology, chemistry, or physics on top of that.
Before you do anything else, confirm your target school's specific HESI requirements. Most admissions offices list required sections on their website, or you can call and ask directly. Knowing exactly what you're facing is step one — and it's the step most students skip.
The exam itself is computer-based and administered at approved testing centers. Some programs now offer proctored online testing as well. Each section is individually timed and scored. You'll receive your scores the same day in most cases, and the testing center submits results electronically to your program.
There are eight content areas that schools can draw from when building their HESI requirement. Here's what each one covers — and what you should expect.
The math section tests practical calculation skills: fractions, decimals, ratios, proportions, basic algebra, and conversions. You'll encounter medical math problems involving dosage calculations and metric-to-imperial conversions — which mirrors what nurses actually do on the job. If math isn't your strong suit, start drilling early. It's not advanced, but it's precise, and small errors matter.
You'll read passages and answer questions about main idea, author's tone, implied meaning, and supporting details. Passages often come from health-related topics, so you may see medical or scientific language. The skill being tested isn't medical knowledge — it's your ability to extract accurate meaning from dense text. That's a critical nursing skill you'll use constantly in clinical documentation.
This section tests academic and health-related vocabulary. Some words are medical terms; others are general academic language you'd find in textbooks. The best prep here is consistent exposure. Don't try to memorize every possible word; instead, focus on learning Greek and Latin roots, prefixes, and suffixes — that gives you a fighting chance with unfamiliar terms.
The grammar section covers parts of speech, subject-verb agreement, punctuation, sentence structure, and common usage errors. If grammar rules feel shaky, invest time here — nursing documentation requires accurate, clear writing, and programs take this seriously.
Expect questions covering cell biology, genetics, metabolism, photosynthesis, and basic ecological concepts. The biology section is conceptual rather than heavily factual — you're expected to understand processes, not just memorize definitions. If you took high school or college biology recently, a targeted review of key concepts should be sufficient.
Chemistry on the HESI covers atomic structure, the periodic table, chemical reactions, bonding, acids and bases, and basic stoichiometry. It's high school chemistry territory, but if it's been a while since your last chem class, budget extra time. The concepts are testable with practice — the more problems you work through, the more intuitive they become.
A&P is one of the most demanding HESI sections, required by a large number of nursing programs. You'll be tested on all major body systems: skeletal, muscular, cardiovascular, respiratory, digestive, nervous, endocrine, urinary, and reproductive. Understanding how systems interact — not just isolated facts — is what the questions target. Visual learning pays off here. Diagrams, organ labeling, and mnemonic devices all help lock in complex material.
Physics isn't required by every program, but when it is, it covers mechanics (force, motion, velocity, acceleration), waves, electricity, and thermodynamics. If physics is new to you, start with foundational concepts before drilling formulas. Understanding the underlying logic of how physical systems work will serve you better than memorizing equations in isolation.
Each HESI section is scored on a scale from 0 to 100. There's no universal pass/fail threshold — that's set by the nursing program you're applying to. Most schools use 75 as a minimum per section, but you'll find programs that set the bar at 70, 80, or even higher for competitive cohorts.
The HESI also generates a composite score — an average across all sections taken. Some schools look at composite scores; others focus on individual section scores. Make sure you know which your target program prioritizes before test day.
If you score below the required threshold, most schools allow a retake — but there's typically a waiting period (often 60 days) before you can test again. Some programs cap total attempts at two or three. That's all the more reason to go in well-prepared the first time.
Something to keep in mind: a higher score doesn't just meet a threshold — it can strengthen your overall application. Many competitive programs receive more qualified applicants than they have seats, and HESI scores are one of the factors used to rank candidates. Shooting for 85+ rather than just 75 gives you a real edge when program seats are limited and the applicant pool is competitive. Every point above the minimum strengthens your file.
The HESI A2 is primarily taken by pre-nursing students applying to RN programs (associate or bachelor's degree) and students entering LPN/LVN programs. Some programs also use the HESI as an internal progression exam — current nursing students take it at checkpoints to assess readiness before advancing or before sitting the NCLEX.
If you're in the pre-admission phase, you're taking the HESI A2 (Admission Assessment). This is the version that determines whether you get accepted into the program. The test is computer-based, timed per section, and administered at approved testing centers — though some schools also allow proctored online testing.
It's also worth knowing that some healthcare programs beyond nursing use the HESI for admission screening — dental hygiene, radiologic technology, and surgical technology programs have all adopted it. If you're pursuing any allied health degree, check whether your program uses the HESI before assuming you only need to worry about nursing-specific exams.
One detail many students miss: you don't have to take all 8 sections in a single sitting. Most schools only require a handful, and you take only what's required. The session length is manageable — typically 3 to 5 hours total — and you can schedule testing at times that fit your preparation timeline. Don't schedule your exam date before you've completed at least two full cycles of practice tests and content review for each required section.
Developed by Elsevier. Used primarily at schools on the Elsevier nursing education platform. Modular format — schools choose which sections to require. Science tested in separate, in-depth sections: Biology, Chemistry, Anatomy & Physiology, Physics. Each section scored 0–100. Composite score calculated across all sections taken. Typically 4–8 sections required depending on program. Retake policy set per school — commonly 60-day wait, 2–3 total attempts.
Developed by ATI. Used at ATI-affiliated nursing programs. Fixed format — all test-takers take the same four sections: Reading, Mathematics, Science, English and Language Usage. Science section is broader, covering life science, earth science, and physical science in a single combined section. Scored by section and overall composite. Generally considered more standardized across programs. Retake policy varies by school but similar wait periods apply.
The answer is simple: prepare for whichever exam your target programs require. If you're applying to multiple schools, check each program's requirements individually — some schools accept both, others require a specific exam. If you need to prepare for both, note that the core academic subjects overlap significantly (math, reading, science). The main difference is depth: HESI goes deeper into individual science subjects, while the TEAS covers science more broadly. Start with the exam required by your top-choice program.
Generic study advice only gets you so far. Here's how to approach each HESI section strategically — because what works for math is very different from what works for A&P, and cramming the same way for every subject is a recipe for uneven scores.
The common thread across all sections is this: active engagement beats passive review every time. Reading your notes is passive. Closing your notes and explaining the material out loud is active. Taking a practice test is active. Highlighting paragraphs you've already highlighted twice is not preparation — it's comfort. Build your study habits around activities that require you to retrieve and apply information, not just reread it. That's the single most impactful shift you can make.
Taking practice tests is the single most effective HESI prep strategy — but only if you do it right. A lot of students take a practice test, check their score, and move on. That approach leaves most of the value on the table.
Here's a better method. After each practice test, spend at least as much time reviewing as you did taking the test. For every question you got wrong, figure out exactly why. Was it a knowledge gap? A misread question? A calculation error? Each type of mistake has a different fix. Knowledge gaps need content review. Misread questions need more careful reading habits. Calculation errors need more timed practice under pressure.
Track your scores over time. If you're consistently scoring in the 70s on chemistry and the 85s on reading, that tells you exactly where to allocate your remaining study time. Progress tracking also gives you a confidence boost as scores improve — which matters when test day nerves kick in.
Simulate test conditions when you practice. Use a timer. Sit at a desk. Minimize distractions. The more your practice sessions resemble actual test conditions, the less disorienting the real thing feels. Don't take your first practice test cold and treat the score as a ceiling — it's a baseline, a diagnostic tool, nothing more. Most students improve significantly with targeted preparation.
There's also a specific technique worth adopting for the HESI — what you might call targeted drilling. After you identify a weak section from your diagnostic, take three or four short focused practice tests in just that subject before moving on. This creates rapid improvement in concentrated areas. Then return to full multi-section practice sessions to assess your overall progress. Alternating between focused and comprehensive practice produces better results than either approach alone.
One more thing: don't ignore the questions you got right. When you review a correct answer, make sure you got it right for the right reason — not because you guessed correctly or remembered the answer from a previous practice test. True comprehension is what transfers to the real exam. Selective review of correct answers catches gaps that score tracking alone can miss.
A solid study plan has three phases: assess, prepare, and refine.
Phase 1 — Assess (Week 1): Take a diagnostic practice test in each required section. Don't study first — take the test cold to get an honest baseline. Record your scores and note which sections need the most attention. This assessment phase is not about performing well; it's about getting accurate data on your starting point.
Phase 2 — Prepare (Weeks 2–6): Spend the bulk of your study time here. Prioritize your weakest sections while maintaining momentum in stronger areas. Use a mix of content review, flashcard work, and timed practice tests. Aim for at least one full practice session per week in each target section. If you have six weeks, use the first three on your bottom two sections and the last three on full balanced review.
Phase 3 — Refine (Final Week): Shift from learning new material to reinforcing what you know. Take full-length timed practice tests. Review errors. Focus on endurance and test-day strategies. Don't cram new concepts in the final 48 hours — trust your preparation and get solid sleep before test day.
One practical note: study in shorter, more frequent sessions rather than marathon cramming. Spaced repetition — returning to material across multiple sessions — produces better retention than reviewing everything at once. Even 45-minute focused sessions daily outperform a single 4-hour Sunday crunch. Consistency is what moves the needle.
A realistic timeline for most students is 4–8 weeks of active preparation, depending on which sections your program requires and how strong your baseline is. If you have significant gaps in science (especially A&P or chemistry), budget toward the longer end. If you're mostly reviewing familiar material, 4–5 weeks of structured prep is often enough to reach competitive scores. The key is honest self-assessment — don't let optimism about your starting point compress your study timeline.