HESI A2 Anatomy and Physiology

Thirty questions on screen. Twenty-five of them scored. Twenty-five minutes.

That is about fifty seconds a question. And because only twenty-five count, every scored question is worth four percentage points. Miss three and you are at 88%. Miss six and you are at 76%. The English and Math exams score fifty items each, so one careless answer there costs two points. Here it costs four. If Anatomy and Physiology is the only science your program requires — and for most candidates it is — this is the tightest-scored exam on your test.

That arithmetic is the reason to treat this exam differently from the rest.

What Elsevier says it covers

The published description is one line: "General A/P terminology, anatomical structures, and systems."

That is the whole official blueprint — thinner than what Elsevier publishes for Biology or Chemistry, which name specific topics. What fills the gap below comes from two places: standard first-year A&P content, and what people who have sat the exam report. Both are labelled as such.

First, check whether you are taking it at all

There is no fixed HESI A2. Your program chooses which exams you sit, so Anatomy and Physiology is either on your test or it is not, and no general study guide can tell you which.

Across 18 nursing program requirement pages we read in full, A&P was required at 9, Biology at 8, Chemistry at 4, and Physics at none. It is the most commonly required science — and it is still on only about half of these tests. Two Arizona community colleges administer no science exam at all.

Read your program's nursing admissions page before you plan a single study session. That page is authoritative. This one is not.

What test-takers report about this exam

Two patterns show up consistently in public candidate accounts, and they are worth knowing before you start.

It is the exam people most often report scoring lowest on. Across multiple independent accounts, A&P is the one that came back below the rest of the set.

It rewards recall breadth, not conceptual depth. One poster on a nursing forum described it as "more like A&P trivia than an attempt to gauge in-depth conceptual knowledge." Others describe it as a wide scatter of single-fact questions rather than a few problems worked through in depth. You are likelier to be asked which valve sits between the left atrium and the left ventricle than to reason about pressure gradients.

These are forum accounts, not a survey. That is what they are worth. But the pattern is consistent enough to prepare around.

The level of this exam is genuinely disputed

Two nursing programs describe the whole HESI A2 as a "high school level" exam. Two others encourage or require applicants to have completed an A&P course before testing, and candidates describe questions reaching the depth of a second-semester A&P course.

That divergence is specific to this exam. Accounts of Biology and Chemistry are consistent with high-school level. The practical consequence: prepare for this one harder than the other sciences, and give it more calendar time than its twenty-five minutes suggests. It is the shortest science exam on the clock and, by most accounts, the widest in content.

The mechanics that change how you practice

You cannot skip and you cannot go back. Your answer locks when you submit it. There is no flag-for-review tool — nothing in Elsevier's documentation or any candidate account describes one. A blank counts as incorrect. The "skip it and come back" habit does nothing here except cost you four points.

With fifty seconds a question and no way back, a guess beats a blank and moving on beats stalling. Commit and go.

Each exam is scored and closed before the next opens. Unused time does not carry over. Finish A&P with four minutes left and those four minutes are gone.

You choose the order you sit them in. Several candidates report taking A&P last, when they were tired, which compounded its randomness. If you get to choose, choose deliberately.

Five of the thirty questions are pilot items that do not count toward your score and are not identified to you. You cannot tell which is which, so answer all thirty as if every one counts.

The areas candidates miss most

These come up repeatedly in candidate accounts of what they got wrong. Start here.

Heart valves

Four valves, two kinds. The atrioventricular valves sit between atria and ventricles: the tricuspid on the right, the mitral (bicuspid) on the left. The semilunar valves sit at the ventricular exits: the pulmonary valve at the right ventricle, the aortic valve at the left.

Know the direction blood moves, in order: vena cavae to right atrium, through the tricuspid to the right ventricle, through the pulmonary valve to the lungs, back by the pulmonary veins to the left atrium, through the mitral valve to the left ventricle, through the aortic valve to the aorta. Chordae tendineae and papillary muscles anchor the AV valves so they do not invert under pressure.

Nephron function

Know which structure does what, in sequence.

• Glomerulus — a capillary tuft where filtration happens under pressure.
• Bowman's capsule — surrounds the glomerulus and collects the filtrate.
• Proximal convoluted tubule — bulk reabsorption: glucose, amino acids, sodium, most of the water.
• Loop of Henle — the descending limb is permeable to water; the ascending limb moves solutes out and is not. That difference builds the concentration gradient in the medulla.
• Distal convoluted tubule — fine-tuned, regulated reabsorption of sodium and secretion of potassium and hydrogen.
• Collecting duct — final water reabsorption, controlled by antidiuretic hormone.

The three processes to keep straight are filtration, reabsorption and secretion.

Hormones and gland identification

For each hormone: which gland releases it, what it targets, what it does.

• Anterior pituitary — growth hormone, TSH, ACTH, FSH, LH, prolactin.
• Posterior pituitary — stores and releases ADH and oxytocin, which are produced in the hypothalamus.
• Thyroid — T3 and T4 set metabolic rate; calcitonin lowers blood calcium.
• Parathyroid — parathyroid hormone raises blood calcium. It is the direct counterpart to calcitonin, and that pair is asked often.
• Adrenal cortex — cortisol and aldosterone, which promotes sodium retention.
• Adrenal medulla — epinephrine and norepinephrine.
• Pancreas — insulin from beta cells lowers blood glucose; glucagon from alpha cells raises it.
• Ovaries and testes — estrogen and progesterone; testosterone.

Major nerves and nervous-system divisions

The central nervous system is the brain and spinal cord. Everything else is peripheral. The peripheral system splits into somatic (voluntary control of skeletal muscle) and autonomic, and the autonomic splits again.

Sympathetic raises heart rate, dilates pupils, opens bronchioles and slows digestion. Parasympathetic does the reverse: slows heart rate, constricts pupils, stimulates digestion. The vagus nerve is the main parasympathetic pathway.

Learn the twelve cranial nerves by number, name and function — olfactory for smell, optic for vision, trigeminal for facial sensation and chewing, facial for expression, vestibulocochlear for hearing and balance, vagus for its wide parasympathetic reach, hypoglossal for the tongue. Also know whether each is sensory, motor or both. Outside the cranial set, the sciatic is the largest nerve in the body and the phrenic supplies the diaphragm.

Blood cell types

• Erythrocytes carry oxygen on hemoglobin. Biconcave, and without a nucleus at maturity.
• Neutrophils are the most numerous white cells and phagocytose bacteria.
• Lymphocytes are the B and T cells of adaptive immunity.
• Monocytes leave the blood and become macrophages.
• Eosinophils respond to parasites and allergic reactions; basophils release histamine.
• Platelets are cell fragments, and they drive clotting.

Plasma is the liquid portion and makes up just over half of blood volume. The formed elements are produced in red bone marrow.

Digestive enzymes

Match the enzyme to the organ that makes it and the substrate it breaks down.

• Salivary amylase — salivary glands, starch.
• Pepsin — stomach, protein. It is secreted as pepsinogen and activated by stomach acid.
• Pancreatic amylase, lipase, trypsin and chymotrypsin — pancreas, acting on starch, fats and proteins respectively.
• Maltase, sucrase, lactase and peptidases — small intestine brush border, acting on disaccharides and short peptides.

Bile is the common trap: the liver produces it and the gallbladder stores it, but it is not an enzyme. It emulsifies fat so lipase can work.

Bone, tissue, muscle and joint classification

Bones by shape: long, short, flat, irregular, sesamoid. By tissue: compact and spongy. Osteoblasts build bone, osteoclasts break it down, osteocytes maintain it. The axial skeleton is skull, vertebral column and rib cage; the appendicular is the limbs and the girdles that attach them.

Joints classify two ways. Structurally: fibrous, cartilaginous, synovial. Functionally: immovable, slightly movable, freely movable. Within synovial joints, know ball-and-socket (shoulder, hip), hinge (elbow, knee), pivot, gliding, saddle and condyloid.

The foundations underneath all of it

Anatomical planes. Sagittal divides left from right; midsagittal does it down the midline. Frontal, also called coronal, divides front from back. Transverse divides superior from inferior.

Directional terms. Superior and inferior, anterior and posterior, medial and lateral, proximal and distal, superficial and deep. Proximal and distal are relative to where a limb attaches to the trunk, which is the pair most often reversed under time pressure.

The four tissue types. Epithelial covers and lines surfaces. Connective is the most varied group and includes bone, blood, cartilage, adipose, tendon and ligament. Muscle contracts. Nervous conducts signals.

The three muscle types. Skeletal is striated and voluntary. Cardiac is striated, involuntary, and joined by intercalated discs. Smooth is neither striated nor voluntary, and lines hollow organs.

About body systems, and the number nobody agrees on

You will be asked about systems: skeletal, muscular, cardiovascular, respiratory, digestive, nervous, endocrine, urinary, lymphatic and immune, integumentary, reproductive.

What you will not find is agreement on how many there are. Published sources divide the body differently, and no authoritative count exists. Any resource that hands you a firm number has picked one convention and not told you. Learn the structures and what they do. Do not memorize a total.

How this exam is scored

You get a percent correct, 0 to 100%. Elsevier sets no passing score for the HESI A2. Your program does.

Observed section minimums run from 60% to 85%, with 75% the most common. Thresholds vary by section as well as by school: one community college requires 82% in Reading but only 68% in Anatomy and Physiology for its associate program. A high bar elsewhere does not mean a high bar here, and the reverse is also true. Read your own program's table.

Elsevier does publish interpretive bands, and these are its words:

There is no percentile. HesiSimulator does not show one either, because a percentile is meaningless without a real population of test-takers behind it.

How to practice this one

Recall breadth is trained by retrieval, not by rereading. Work in lists and pairs — gland to hormone, enzyme to substrate, valve to chamber — and test yourself cold rather than reviewing notes you have already seen.

Then practice it timed, in one sitting, with answers that lock. Thirty questions in twenty-five minutes is a pace, and pace is a separate skill from knowledge. A HESI A2 anatomy and physiology practice test that lets you skip, flag and revise is rehearsing a test you will not sit. The simulator runs the real count, the real clock and the real answer-locking, and every question carries a worked explanation, so a wrong answer tells you which fact to relearn.

Do that once before you decide how much more studying you need. Four points a question is a thin margin, and it is easier to find out where you stand now than on the day.

Independent. Not affiliated with, endorsed by, or sponsored by Elsevier or HESI.