HESI A2 Anatomy & Physiology: The Complete Study Guide

If there is one section that decides whether a nursing school application stands out, it is the HESI A2 Anatomy and Physiology test. Students consistently report it as the hardest part of the exam, and average scores on this section run well below the others. The good news is that the section is predictable. It rewards memorization, repetition, and a clear study plan far more than natural test-taking instinct.

This guide walks through everything you need to master the HESI A2 Anatomy and Physiology section: how the section works, the high-yield body systems, directional terms, a hormones and glands table, and a study strategy that actually fits your schedule. For the full picture of the exam, start with our HESI A2 study guide.

What the Anatomy and Physiology Section Tests

The Anatomy and Physiology section has 25 scored questions plus a small number of unscored pilot items, and you get about 25 minutes to complete it. That works out to roughly 50 seconds per question. Because the time per question is short, the section tests recall rather than deep reasoning. You either know that the nephron is the functional unit of the kidney, or you do not.

The section pulls from every major body system, which is exactly why it feels so broad:

• Cardiovascular, respiratory, renal, and nervous systems
• Skeletal, muscular, and integumentary systems
• Endocrine and digestive systems
• Cellular biology, tissue types, and basic genetics
• Anatomical terminology and body planes

Because only 25 questions cover all of this, every question matters. You cannot afford a weak system. According to this HESI A2 exam guide from OpenExamPrep, the section averages between 65 and 72 percent, the lowest of any section on the exam, which is why students who take it seriously pull ahead of the pack.

Directional Terms and Body Planes You Must Know Cold

Anatomical terminology appears early in nearly every A&P review and on the exam itself. These terms describe where structures sit in relation to each other, and getting them right costs you nothing if you drill them once.

Term	Meaning
Anterior	Toward the front of the body
Posterior	Toward the back of the body
Superior	Above or toward the head
Inferior	Below or toward the feet
Medial	Toward the midline of the body
Lateral	Away from the midline
Proximal	Closer to the trunk
Distal	Farther from the trunk
Superficial	Near the body surface
Deep	Farther inside the body
Supine	Lying face up
Prone	Lying face down

You should also know the three body planes: the sagittal plane divides the body into left and right, the frontal plane divides it into front and back, and the transverse plane divides it into top and bottom.

The High-Yield Body Systems

You do not need to memorize every structure in the body. You need to master the systems and facts that appear most often. Here is what to study first, one system at a time.

Cardiovascular System

Know the path of blood through the heart in order: body to the vena cava, right atrium, through the tricuspid valve to the right ventricle, through the pulmonic valve to the lungs, back through the pulmonary veins to the left atrium, through the mitral valve to the left ventricle, and out the aortic valve to the body.

Three facts earn repeated credit: the left ventricle is the thickest chamber because it pumps blood to the entire body, arteries carry blood away from the heart, and veins carry blood back to it. The heart has four valves in total, and the right side of the heart pumps to the lungs while the left side pumps to the body.

Respiratory System

Trace the air pathway: nose to pharynx to larynx to trachea to bronchi to bronchioles to alveoli. Gas exchange happens in the alveoli, the tiny air sacs in the lungs. The diaphragm contracts and moves down when you inhale, creating space for the lungs to fill. The right lung has three lobes and the left has two, because the heart takes up space on the left side.

Urinary System

The nephron is the functional unit of the kidney, and filtration happens at the glomerulus. The kidneys regulate fluid balance, electrolytes, blood pressure, and pH, and they release erythropoietin, the hormone that stimulates red blood cell production. The urine pathway is kidney to ureter to bladder to urethra.

Skeletal System

The adult skeleton has 206 bones, divided into the axial skeleton (skull, spine, ribs, and sternum) and the appendicular skeleton (limbs and shoulder and hip girdles). Red bone marrow produces blood cells, and the femur is the longest and strongest bone in the body.

Muscular System

There are three types of muscle: skeletal muscle is voluntary and striated, cardiac muscle is involuntary and striated and found only in the heart, and smooth muscle is involuntary and non-striated and found in organs and blood vessels.

Nervous System

The central nervous system is the brain and spinal cord, and the peripheral nervous system is everything else. The neuron is the basic unit, with axons sending signals and dendrites receiving them. In the brain, the cerebrum handles thought and voluntary movement, the cerebellum manages balance and coordination, and the medulla controls heart rate and breathing.

Endocrine System

The pituitary gland is the master gland because it directs many others. The thyroid regulates metabolism, the adrenal glands release cortisol and epinephrine, and the pancreas releases insulin and glucagon to control blood sugar. A complete hormone table is below.

Digestive System

Food travels from the mouth to the esophagus, stomach, small intestine, large intestine, and rectum. Most nutrient absorption happens in the small intestine, and the large intestine absorbs water. The liver produces bile, and the pancreas releases digestive enzymes.

Integumentary System

The skin has three layers: the epidermis on the outside, the dermis below it, and the hypodermis, also called the subcutaneous layer, underneath. The skin protects the body, regulates temperature, provides sensation, and produces vitamin D.

Hormones and Glands Table

Hormone questions are some of the most reliable on the exam because the list is finite. Memorize the gland, the hormone, and the main job, and you cover most of what the section asks.

Gland	Hormone	Main Job
Hypothalamus	Releasing hormones	Controls the pituitary gland
Pituitary, anterior	Growth hormone, TSH, ACTH, FSH, LH, prolactin	Directs growth, metabolism, stress response, and reproduction
Pituitary, posterior	ADH, oxytocin	ADH retains water; oxytocin triggers labor and milk release
Thyroid	Thyroxine (T4), triiodothyronine (T3), calcitonin	Controls metabolism; calcitonin lowers blood calcium
Parathyroid	Parathyroid hormone	Raises blood calcium
Adrenal cortex	Cortisol, aldosterone	Cortisol manages stress and blood sugar; aldosterone balances sodium and water
Adrenal medulla	Epinephrine, norepinephrine	Fight or flight response
Pancreas	Insulin, glucagon	Insulin lowers blood glucose; glucagon raises it
Ovaries	Estrogen, progesterone	Control the menstrual cycle and secondary sex characteristics
Testes	Testosterone	Controls sperm production and male characteristics
Thymus	Thymosin	Matures T cells for the immune system
Pineal	Melatonin	Regulates the sleep-wake cycle

Cells, Tissues, and Basic Genetics

A handful of questions come from the cellular level. Know that the cell membrane controls what enters and leaves, the nucleus holds DNA, mitochondria produce energy as ATP, and ribosomes build proteins. Mitosis produces two identical body cells, while meiosis produces four gametes with half the chromosomes. The four tissue types are epithelial, connective, muscle, and nervous tissue, and the immune system defends the body with white blood cells and antibodies.

How to Study for A&P

The official HESI A2 study resources from Elsevier notes that this is a recall section, not a reasoning section, which makes it the most predictable part of the exam and the best use of your study time. Use these steps:

• Study one body system at a time and finish it before moving on. Partial knowledge of every system scores worse than solid knowledge of most of them.
• Draw or label diagrams for the heart, respiratory tract, nephron, and neuron. Labeling exercises force recall better than rereading.
• Drill the directional terms and the hormone table until they are automatic, because these are free points.
• Use spaced repetition for the memorization-heavy facts. Review yesterday's system for ten minutes before starting today's.
• Take timed practice sets under the real 50-seconds-per-question pace so the speed feels normal on test day.

When you are ready to check your progress, use our HESI A2 prep page for practice tests built around the real section format, and remember that most programs set a minimum score rather than a fixed passing bar, so check our guide to what counts as a good HESI A2 score.

Final Thoughts

Anatomy and Physiology is the section where preparation pays off the most. The content is vast, but the exam is predictable, the questions reward recall, and the highest-yield facts fit neatly into a study plan you can finish in a few weeks. Study one system at a time, drill the tables in this guide, practice under real timing, and this section can go from your biggest fear to your biggest strength.