Free HESI A2 Grammar guide
October 2026 - Coherence in Writing Study Guide for nursing students in
Coherent writing moves in a logical order and signals each move with transitions such as however, therefore, in addition and as a result. Every sentence should connect to the one before it — and choosing the transition that matches the actual relationship is what these questions test.
Transitions by relationship
Choose by the logical connection, not by which word sounds most academic.
| Relationship | Transitions |
|---|---|
| Addition | also, in addition, furthermore, moreover, besides |
| Contrast | however, nevertheless, on the other hand, in contrast, yet |
| Cause and effect | therefore, consequently, as a result, thus, so |
| Example | for example, for instance, specifically, to illustrate |
| Sequence | first, next, then, meanwhile, finally |
| Concession | admittedly, granted, of course, it is true that |
| Conclusion | in short, overall, in conclusion, to summarise |
The most common wrong answer is a transition of the wrong type — usually "however" where the two sentences agree, or "therefore" where no cause is involved. Read the two sentences on either side of the gap and name the relationship before looking at the options.
What coherence requires beyond transitions
- Logical order — chronological for a process, general to specific for an explanation, or problem to solution for an argument.
- Unity — every sentence in the paragraph supports its topic sentence. A true, interesting, unrelated sentence still breaks it.
- Consistent perspective — do not shift between "a nurse", "you" and "we" within a passage.
- Consistent tense — a passage that starts in the past should stay there unless the time genuinely changes.
- Clear pronoun reference — a reader should never have to work out what "this" refers to.
The given-new pattern
Coherent paragraphs tend to open each sentence with something the reader already has, and put the new information at the end. That is why a sentence beginning "This delay meant that…" reads smoothly after a sentence about a delay, and why the same content in the reverse order feels disjointed.
It is a useful editing test. If a sentence introduces something entirely new in its first few words, and connects to the previous sentence only at the end, reversing the halves usually improves the flow immediately.
Choosing a transition
Worked example
Fill the gap: The new rota was designed to distribute night shifts evenly. ____, three members of staff ended up with four consecutive nights.
- Read the first sentence: the rota was intended to spread nights evenly.
- Read the second: some staff got four in a row.
- Name the relationship: the outcome contradicts the intention. That is contrast.
- Pick a contrast transition rather than an additive or causal one.
However or Nevertheless. "Therefore" would be wrong because the second sentence is not a consequence of the design but a failure of it, and "in addition" would suggest the two sentences agree.
Terms to know
- Coherence
- The quality of writing that holds together and moves logically.
- Cohesion
- The surface links — transitions, repeated terms, pronouns — that make coherence visible.
- Transition
- A word or phrase signalling the relationship between ideas.
- Unity
- Every sentence in a paragraph supporting its main point.
- Conjunctive adverb
- however, therefore, moreover — transitions that need a semicolon or full stop, not a comma.
- Parallel structure
- Matching grammatical form across items in a list or comparison.
What the HESI asks most
The same core ideas appear in different wording. If you can answer these without stopping to think, you have what this section requires.
Which transition best fits the gap?
Name the relationship between the two sentences first, then pick a transition of that type.
Which sentence does not belong in this paragraph?
The one that does not support the topic sentence, however true it is.
In what order should these sentences be arranged?
Find the topic sentence, then follow the transitions and pronouns, which point backwards to what they follow.
Key points
- Match the transition to the relationship: addition, contrast, cause, example, sequence.
- "However" signals contrast; "therefore" signals a consequence. Neither is a general-purpose connector.
- Unity means every sentence supports the paragraph's point.
- Keep person and tense consistent across a passage.
- Old information first, new information last, makes sentences flow.
Review quiz
4 questions on this topic, each with the reasoning worked through. Pick an answer to see how it went, or open the explanation straight away.
-
Question 1 of 4
Which transition best completes the gap?
The clinic extended its opening hours. ____, the number of missed appointments fell by a third.Show the answer and explanation
Correct answer: B. As a result
The second sentence reports a consequence of the first, which calls for a cause-and-effect transition. All three of the other options signal contrast, which would wrongly suggest the fall in missed appointments worked against the extended hours.
-
Question 2 of 4
Which sentence does not belong in this paragraph?
Handover is the point at which most information is lost. Studies consistently find that details omitted at handover are rarely recovered later. A structured handover tool reduces those omissions substantially. The hospital canteen closes at eight.Show the answer and explanation
Correct answer: D. The fourth sentence
The canteen sentence is true and entirely unrelated to handover, which breaks the paragraph's unity. The other three build a single argument: the problem, the evidence for it, and a measure that addresses it.
-
Question 3 of 4
Which revision improves coherence?
A nurse should document immediately after care is given. You will forget details otherwise.Show the answer and explanation
Correct answer: A. A nurse should document immediately after care is given, because details are otherwise forgotten.
The original shifts from "a nurse" to "you" mid-passage, and the fix keeps one consistent perspective while making the causal link explicit. The second choice keeps the shift and adds a contrast transition where the relationship is causal, and the third simply reverses the inconsistency.
-
Question 4 of 4
Which transition signals a concession rather than a contrast?
Show the answer and explanation
Correct answer: C. Admittedly
"Admittedly" grants a point to the other side before the writer continues with their own, which is what a concession does. The other three set two things against each other without conceding anything.
Put this HESI topic into practice
Build a set on coherence in writing and use the rationale on every question to reinforce what you just reviewed.
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