HESI Grammar Test Overview

The Grammar section of the HESI A2 exam assesses a student’s understanding of standard English grammar rules and their ability to apply them correctly. Strong grammar skills are essential in healthcare education and practice, where precise written communication — in patient notes, care plans, professional correspondence, and academic assignments — can have real consequences for clarity and patient safety.

Purpose and Context

Nursing and allied health programs demand a high level of written communication competency. Students must write clearly and correctly in clinical documentation, academic papers, and interprofessional communication. Errors in grammar can obscure meaning, create ambiguity, or undermine professional credibility. The HESI Grammar section ensures that incoming students have a solid enough command of English to meet these demands from day one.

Test Format

The Grammar section typically consists of 50 questions and is allotted approximately 50 minutes. It is computer-based and entirely multiple choice. Questions generally present a sentence or partial sentence and ask you to identify an error, choose the correct word or phrase, or select the best version of a construction from four options. Confident, automatic recognition of grammar rules is more valuable here than slow deliberation.

Topics and Skills Assessed

Parts of Speech A foundational layer of the test involves correctly identifying and using the eight parts of speech — nouns, pronouns, verbs, adjectives, adverbs, prepositions, conjunctions, and interjections. Understanding how each functions within a sentence is essential for navigating nearly every other grammar topic on the test.

Nouns and Pronouns Noun questions often focus on pluralization — including irregular plurals like criteria, phenomena, and data — and possessives. Pronoun questions are among the most common and cover pronoun-antecedent agreement, pronoun case (subjective, objective, and possessive forms), and pronoun clarity. Tricky constructions involve indefinite pronouns like everyone or each, which are singular despite feeling plural.

Verbs and Verb Tense Subject-verb agreement is heavily tested, with particular attention to sentences where the subject and verb are separated by a long phrase, compound subjects joined by or or nor, and collective nouns. Verb tense questions assess correct use of past, present, future, and perfect tenses, as well as tense consistency. Irregular verb forms — such as lie/lay, sit/set, and rise/raise — appear frequently because they are commonly misused even by fluent speakers.

Adjectives and Adverbs These questions test whether you can distinguish between adjectives, which modify nouns, and adverbs, which modify verbs, adjectives, or other adverbs. A common error involves using an adjective where an adverb is required — writing She spoke clear instead of She spoke clearly. Comparative and superlative forms are also tested, including when to use -er/-est versus more/most constructions.

Sentence Structure This category covers complete sentences versus fragments, run-on sentences, comma splices, and parallel structure. You may also be asked about how subordinate and coordinate clauses are correctly combined using appropriate conjunctions and punctuation.

Punctuation Punctuation questions focus primarily on comma usage — in compound sentences, after introductory phrases, in series, and with nonessential clauses. Apostrophe use in possessives and contractions is another frequent topic. Semicolons and other punctuation marks appear occasionally.

Commonly Confused Words This is one of the most consistently tested categories. Expect homophones and near-homophones such as their/there/they’re, your/you’re, its/it’s, then/than, affect/effect, who/whom, fewer/less, and good/well. Mastering these is one of the most reliable ways to improve your score, as the rules are finite and learnable.

Misplaced and Dangling Modifiers These questions present sentences where a descriptive phrase is poorly positioned, creating ambiguity or an unintended meaning. Recognizing and correcting these errors requires a clear understanding of how sentence structure conveys meaning.

Double Negatives These questions test whether students can identify and correct the use of two negative words in a single clause — for instance, recognizing that She didn’t say nothing should be corrected to She didn’t say anything or She said nothing.

Scoring

Like all HESI A2 sections, Grammar is scored on a 0–100% scale. Most programs require a minimum of 75%, with more selective programs setting the cutoff at 80% or higher. Grammar is one of the more rulebook-driven sections on the exam, meaning that most questions have a clear, defensible correct answer — making it very responsive to focused preparation.

How It Compares to Other Sections

Many test-takers rely on an intuitive feel for grammar developed through years of reading and writing, but intuition alone isn’t always reliable — particularly for pronoun case, tricky subject-verb agreement, and commonly confused words. Students who have been out of formal schooling for a while, or who learned English as a second language, may need to invest more preparation time here than in other sections.

Preparation Tips

Study grammar rules explicitly. Knowing the underlying rule gives you a principled basis for choosing the correct answer rather than relying on what "sounds right," which can mislead you.

Prioritize high-frequency topics. Subject-verb agreement, pronoun usage, verb tense, and commonly confused words account for a large share of the questions. Front-load your preparation with these areas if study time is limited.

Memorize the commonly confused word pairs. Study each pair until the distinction is automatic. These questions are straightforward when you know the rule — and knowing it means a near-guaranteed correct answer.

Practice identifying errors actively. Work through practice sentences and try to spot the error before looking at the answer choices. This trains the active recognition skill the test demands.

Use HESI-specific materials. The official Elsevier HESI Admission Assessment Exam Review guide contains grammar practice questions formatted to mirror the real exam, and is the most reliable preparation resource available.

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Overall, the HESI Grammar section is one of the most preparation-responsive parts of the entire exam. The rules are finite, learnable, and consistently applied. A student who invests focused time in understanding them is very well-positioned to score well above the minimum cutoff.