HESI A2 Anatomy and Physiology Study Guide: What to Expect and How to Prepare

The HESI A2 (Health Education Systems, Inc. Admission Assessment) is a pre-admission exam used by hundreds of nursing schools to evaluate applicants. The Anatomy and Physiology (A and P) section is one of the most challenging portions because it draws on content from a full two-semester A and P course. Knowing which systems are tested most heavily and how to approach the material strategically can make the difference between an average score and one that gets you admitted.

HESI A2 A and P Section Overview

The Anatomy and Physiology section contains approximately 25-30 questions, depending on the version your school requires. Questions test both anatomical knowledge (structures and their locations) and physiological understanding (how those structures function and interact). The HESI A2 does not penalize for wrong answers, so always attempt every question.

Scores are reported as a percentage. Most nursing programs expect a minimum score of 75-80% on this section, though competitive programs may require 85% or higher. Check your target school’s specific minimum before you begin studying so you know what benchmark to aim for.

The content is drawn from all major body systems, with some systems receiving more questions than others based on their relevance to nursing practice.

Highest-Yield Body Systems

Not all systems appear equally on the HESI A2 A and P section. Focus the most study time on these high-yield areas:

• Cardiovascular system: Heart anatomy (chambers, valves, great vessels), the cardiac cycle, blood pressure regulation, and the conduction system. Know the path of blood through the heart from entry at the vena cava to exit through the aorta.
• Respiratory system: Upper and lower respiratory tract structures, alveolar gas exchange, the mechanics of breathing, and how the diaphragm and intercostal muscles work together. Understand partial pressure gradients for oxygen and carbon dioxide.
• Musculoskeletal system: Major bones, muscle types (skeletal, smooth, cardiac), types of joints, and the sliding filament theory of muscle contraction. Know the difference between origin and insertion.
• Nervous system: Central vs. peripheral nervous system divisions, neuron anatomy, synapse mechanics, the autonomic nervous system (sympathetic vs. parasympathetic), and major brain regions and their functions.
• Endocrine system: Major glands (pituitary, thyroid, adrenal, pancreas), the hormones they produce, and the target effects of each hormone. Understand negative feedback loops.

Additional Systems to Review

These systems appear less frequently but still contribute to your final score:

• Digestive system: Organs and their accessory structures, the sequence of digestion, enzyme functions, and nutrient absorption sites in the small intestine.
• Urinary system: Kidney anatomy (nephron structure, glomerulus, tubules), urine formation steps (filtration, reabsorption, secretion), and the roles of the ureters, bladder, and urethra.
• Reproductive system: Male and female anatomy, the menstrual cycle, and hormonal control of reproduction (FSH, LH, estrogen, progesterone).
• Integumentary system: Layers of skin (epidermis, dermis, hypodermis), functions (thermoregulation, sensation, protection), and types of glands.
• Lymphatic and immune system: Lymph node locations, the role of lymphocytes (B cells and T cells), and the difference between innate and adaptive immunity.

Effective Study Strategies for HESI A2 A and P

Because A and P covers an enormous amount of material, a structured approach is essential:

1. Use a visual-first strategy. Anatomy is spatial. Draw and label diagrams of each system from memory. Labeling a blank heart diagram repeatedly is more effective than re-reading text descriptions.
2. Connect structure to function. For every anatomical structure you learn, immediately ask: what does this do? HESI A2 questions frequently describe a function and ask you to identify the responsible structure.
3. Create a system-by-system one-page summary covering major structures, key hormones or enzymes, and one clinical connection (for example, where a kidney stone would cause pain). One-page summaries force prioritization and serve as rapid review sheets.
4. Take timed practice tests by body system before doing mixed-topic tests. This builds confidence in each area before you need to recall everything at once.
5. Review physiology through cause-and-effect chains. For example: low blood pressure triggers renin release, which triggers angiotensin II, which causes vasoconstriction and aldosterone release, which increases sodium and water retention. Understanding the chain beats memorizing isolated facts.

Common Mistakes and How to Avoid Them

Students who underperform on the HESI A2 A and P section often make the same preventable mistakes:

• Studying only from memory cards without understanding. HESI A2 questions test application and comprehension, not just recall. Knowing that the mitral valve is between the left atrium and left ventricle is not enough; you also need to know what happens when it is damaged.
• Skipping physiology in favor of anatomy. Many students find anatomy (names and locations) easier than physiology (mechanisms and regulation). The exam tests both equally, so do not neglect physiology.
• Using a single resource. No one textbook or app covers the HESI A2 A and P exactly. Cross-reference your A and P textbook with HESI-specific prep books and practice question banks.
• Studying too broadly. A standard two-semester A and P textbook contains far more detail than the HESI A2 tests. Focus on major concepts, normal ranges, and clinically relevant physiology rather than advanced biochemistry.

Sample Topics and How Questions Are Phrased

HESI A2 A and P questions often take one of these forms:

• Identification: ‘Which structure separates the right atrium from the right ventricle?’ (Answer: tricuspid valve)
• Function: ‘Which organ is primarily responsible for regulating blood glucose levels?’ (Answer: pancreas)
• Process: ‘During which phase of the cardiac cycle does the ventricle fill with blood?’ (Answer: diastole)
• Clinical connection: ‘A patient has damage to the myelin sheaths of motor neurons. Which function would be most directly impaired?’ (Answer: speed of nerve signal conduction)

Practice writing your own questions as you study. Turning your notes into question-and-answer pairs mirrors the exam format and reinforces active recall. Aim to complete at least 150-200 A and P practice questions before your exam date.