The HESI A2 is moderately difficult, with first-attempt scores averaging in the 60-69% range. That matters because most nursing programs require a 75-80% or higher to qualify for admission. The gap between what students typically score on their first try and what schools actually accept is where the real challenge lies. With focused preparation, though, the exam is very passable.
What the Exam Covers
The HESI A2 (Admission Assessment) is a nursing school entrance exam with sections in English, math, and science. A full version includes reading comprehension, vocabulary and general knowledge, grammar, basic math skills, and anatomy and physiology. Each academic section contains 55 questions (50 scored, 5 unscored pilot questions) with about 50-60 minutes per section, except anatomy and physiology, which has 30 questions in 25 minutes. There’s also an ungraded personality profile and learning style assessment that doesn’t count toward your score.
Here’s the key detail that makes difficulty hard to pin down: the HESI A2 is customizable. Unlike the TEAS, which gives every student the same standardized test, nursing programs pick which HESI sections they require. One school might only ask for math and reading comprehension. Another might include anatomy and physiology, chemistry, and biology. Your experience with the HESI depends heavily on which school you’re applying to, so checking your program’s specific requirements is the first step in preparation.
Which Sections Are Hardest
Anatomy and physiology consistently ranks as the most difficult section. It requires genuine content knowledge that you either have or don’t. You need to understand body systems, organ functions, and how structures relate to each other. Unlike reading comprehension or vocabulary, where strong general skills can carry you, anatomy demands specific recall.
Math trips up more students than you might expect, not because the concepts are advanced, but because the questions cover a wide range of topics: fractions, decimals, ratios, percentages, conversions, and basic algebra. Many students haven’t worked with these skills recently, and small mistakes with unit conversions or decimal placement add up fast. Some schools set a separate minimum score for math alone. Palm Beach State College, for example, requires at least an 80 on the math section independently of your cumulative score.
Reading comprehension is generally rated the easiest section. The passages test your ability to identify main ideas, make inferences, and understand context. If you’re a comfortable reader, this section requires less preparation than the others. Vocabulary and grammar fall somewhere in the middle. The vocabulary leans toward medical and academic terms you may not use daily, so it rewards students who study word lists in advance rather than relying on intuition.
Score Requirements by Program
What counts as “passing” the HESI varies by school and program type. There is no universal passing score set by Elsevier, the company that makes the exam. Instead, each nursing program sets its own cutoff. For registered nursing (RN) programs, a cumulative score of 80% is a common minimum. Licensed practical nursing (LPN) programs often set the bar slightly lower, around 75%. Competitive programs may expect scores in the mid-80s or higher, especially when they’re ranking applicants against each other for limited seats.
Your cumulative score is an average across all the sections your school requires. That means a strong performance in reading or grammar can offset a weaker math or science score, to a point. But some programs also set individual section minimums, so you can’t afford to completely neglect any one area.
How It Compares to the TEAS
The TEAS and HESI A2 are the two main nursing entrance exams, and students often wonder which is harder. The answer depends on your strengths. The TEAS covers broader, more standardized academic content across reading, math, science, and English in a fixed format. The HESI can feel easier or harder depending on which sections your school selects. Students with strong science backgrounds often find the TEAS more manageable, while students who do well with targeted subject preparation may prefer the HESI’s format.
The HESI’s customizable nature is both an advantage and a complication. You can focus your study time on exactly what your program requires, but you also can’t rely on generic advice about the test since your version might look quite different from someone else’s.
Retake Rules and Limits
If your first attempt doesn’t go well, most schools allow retakes, but with restrictions. A common policy requires a six-week waiting period between attempts, with a maximum of two attempts per application cycle. Schools typically use your highest score from the past year, so an improved second attempt replaces a weaker first one. However, HESI scores generally expire after 12 months, meaning you’ll need to retest if you don’t apply within that window.
These waiting periods matter for planning. If your program has a fixed application deadline, a failed first attempt in the wrong month could leave you without time for a retake. Building in buffer time is worth considering.
How Long to Study
A reasonable preparation timeline is about six weeks, dedicating a few hours per week to focused study. Western Technical College recommends at least one week per academic section as a baseline. So if your school requires four sections, four to six weeks of consistent study gives you enough time to cover all the material without cramming.
A practical six-week plan might look like spending the first four weeks on one section at a time, then using the remaining two weeks for review and practice tests. Students who score well on their first attempt almost always point to practice exams as the single most useful preparation tool. They familiarize you with the question style, reveal weak spots, and help with time management. The HESI’s time limits are fairly generous for most sections, but anatomy’s 25 minutes for 30 questions moves faster than you’d expect.
If you’ve been out of school for a while, plan on extra time for math fundamentals and any science sections. Students coming directly from prerequisite courses in biology or anatomy typically need less review in those areas. Your starting point matters more than any fixed number of study hours.
What Makes It Manageable
The HESI A2 isn’t designed to trick you. The questions are straightforward and content-based, not riddled with confusing wording or intentional misdirection. If you know the material, you’ll recognize the correct answer. That’s different from exams like the NCLEX, which tests clinical judgment through complex scenario questions. The HESI is testing whether you have the foundational knowledge to succeed in nursing school, not whether you can already think like a nurse.
The biggest risk factor isn’t the exam’s inherent difficulty. It’s underestimating it. Students who walk in without preparation, assuming general knowledge will be enough, are the ones landing in that 60-69% average range. Students who spend a few weeks reviewing content and taking practice tests consistently score above the thresholds their programs require. The gap between those two groups is preparation, not ability.