The HESI exam is a standardized test made by Elsevier that nursing programs use at two key points: before you get into nursing school and right before you graduate. The version you take for admission is called the HESI A2 (Admission Assessment), and it tests your academic readiness in subjects like math, reading, and anatomy. The version taken near graduation is the HESI Exit Exam (E2), which predicts how likely you are to pass the NCLEX licensing exam. Most people searching this term are looking at the A2, so that’s where we’ll start.
The HESI A2: Your Nursing School Entrance Exam
The HESI A2 is an admissions tool that nursing programs use to evaluate whether applicants have the foundational knowledge to succeed in a nursing curriculum. It’s not the only nursing entrance exam out there (the TEAS is another popular one), but hundreds of programs across the country require the HESI A2 specifically. Your scores on the A2, along with your GPA and other application materials, determine whether you get a seat in the program.
Each nursing school sets its own minimum score requirements, so the same score that gets you accepted at one school might not be enough at another. Programs also vary in which sections of the exam they require, so checking with your specific school before registering is essential.
What Subjects the A2 Covers
The HESI A2 is divided into several sections, each with its own question set. The core academic sections are:
- Reading Comprehension: 55 questions testing your ability to interpret passages, identify main ideas, and draw conclusions.
- Vocabulary: 55 questions on general knowledge and word meanings commonly used in healthcare contexts.
- Grammar: 55 questions covering sentence structure, punctuation, and standard English usage.
- Math: 55 questions on basic arithmetic, fractions, ratios, percentages, and conversions. An on-screen calculator is available.
- Anatomy and Physiology: 30 questions on body systems and how they function.
Some programs also require Biology and Chemistry sections. Beyond the academic portions, the exam includes a Learning Style assessment and a Personality Profile, each taking about 15 minutes. These aren’t scored the same way as the academic sections. They’re designed to give you insight into how you study and work, not to determine whether you’re admitted.
How Long the Exam Takes
You get a total of 4 hours and 15 minutes to complete the entire exam. Each section has a recommended time allotment: 60 minutes for Reading Comprehension, 50 minutes each for Vocabulary, Grammar, and Math, and 25 minutes for Anatomy and Physiology. The Learning Style and Personality Profile sections get about 15 minutes each. These are recommended paces rather than hard cutoffs at most testing sites, but the overall 4.25-hour window is firm.
Question Format
The A2 is primarily multiple-choice. You’ll select one correct answer from four options for most questions. Some versions include fill-in-the-blank items, particularly in the math section where you may need to calculate and type in a numerical answer. The format is straightforward compared to the more complex question styles you’ll encounter later in nursing school and on the NCLEX.
Cost, Registration, and Retakes
The HESI A2 typically costs around $51, though fees can vary slightly depending on the testing location. You’ll need a valid photo ID to sit for the exam, and payment is usually collected at the testing center on exam day. Registration is handled through your school’s testing center or through the Evolve platform (Elsevier’s online system), not through a centralized national site.
If your scores aren’t where you need them, most programs allow retakes with restrictions. A common policy is up to three attempts within a 12-month period, with a minimum of 60 days between each attempt. Your school may have stricter rules, so verify before scheduling a retake. Some programs accept only your most recent score, while others take your highest.
How to Prepare
Elsevier publishes an official study guide, the Admission Assessment Exam Review, now in its sixth edition. It covers every subject area on the exam and includes hundreds of sample questions with step-by-step explanations. The guide starts with a 25-question pre-test so you can identify weak areas before diving in, and ends with a 50-question post-test with rationales for both correct and incorrect answers. An online companion site offers additional practice exams with over 200 questions.
Beyond the official guide, many students use free resources like Khan Academy for math review and anatomy flashcard apps for body systems. The vocabulary section tends to catch people off guard because it focuses on words used in medical and scientific contexts, not everyday language. Spending extra time on medical terminology pays off. For math, practice unit conversions and dosage-style ratio problems, since these appear frequently and trip up students who haven’t touched math in a while.
The HESI Exit Exam: Predicting NCLEX Success
The other major HESI exam in nursing is the Exit Exam, or E2, taken near the end of your nursing program. This one doesn’t determine admission. It measures whether you’re ready to pass the NCLEX-RN, the national licensing exam that allows you to practice as a registered nurse.
The predictive power of the E2 is well documented. A large study spanning over 40 nursing programs and nearly 3,700 students found that those who scored 900 or higher on the E2 passed the NCLEX-RN between 96.4% and 99.2% of the time. Students scoring between 850 and 899 still had a 93.8% likelihood of passing. For students with an average E2 score of 850 or above, the first-time pass rate on the NCLEX-RN was 96.33%.
These numbers explain why many nursing programs set minimum E2 scores as a graduation requirement or use them to identify students who need additional preparation before attempting the NCLEX. Some programs require students who score below a certain threshold to complete remediation courses or additional practice exams.
How HESI Scores Work
HESI scores are reported on a scale where 900 and above is generally considered excellent. Here’s how most programs interpret the ranges:
- 900 and above: Excellent. Strong likelihood of success in the program or on the NCLEX.
- 800 to 899: Very good. Meets most program requirements.
- 750 to 799: Satisfactory. May meet minimum thresholds at some schools but not others.
- Below 750: Needs improvement. Many programs will not accept scores in this range.
Each section is scored individually, and some programs look at a composite (average of all sections) while others set minimums for each section separately. A strong math score won’t compensate for a low reading score if your program requires minimums in both.
HESI vs. TEAS: Which One You’ll Take
The TEAS (Test of Essential Academic Skills), made by ATI, is the other major nursing entrance exam. You don’t choose between them. Your program requires one or the other, and occasionally accepts both. The content overlap is significant: both test reading, math, science, and English skills. The main differences are in structure, scoring scales, and which publisher’s ecosystem your school uses. If your program requires the HESI, focus your preparation there. The skills are transferable, but the question styles and content emphasis differ enough that studying for the wrong exam wastes time.