In the test question "My grandmother has gray hair" why do you use tiene instead of the familiar form "tienes". You are referring to YOUR grandmother. Wouldn't that be familiar?
This is a question about conjugation. So if you were talking directly to her you would say "Grandmother YOU have grey hair" which is the second person singular "tienes".... "Abuela, tienes pelo gris."
When you are talking about someone rather than to them, which is what the example sentence is doing, you would use the third person singular "My grandmother (she) has grey hair which translates as "Mi abuela tiene pelo gris."
I hope that helps.
Exactly as John says.
To realize if you are talking directly to someone or as a third person (he, she) you will normally see a comma:
Grandma, you have grey hair. (directly to her)
Abuela, tienes el pelo gris.
My grandma has grey hair. (as a third person)
Mi abuela tiene el pelo negro.
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Test your Spanish to the CEFR standard