English Grammar & Language Usage

Master the grammar and language usage skills tested on the HESI A2 Grammar section and ATI TEAS English & Language Usage section — and used every day in nursing documentation. Covers parts of speech, sentence structure, agreement rules, punctuation, and common errors.

Parts of Speech

The building blocks of every sentence

Parts of speech describe how words function in a sentence. Understanding them is the foundation for identifying grammar errors on the HESI A2 and TEAS, and for writing accurate nursing documentation.

The Eight Parts of Speech

Parts of Speech — Self-Check

1/3

In the sentence 'The patient reported severe pain,' the word 'severe' is a:

Sentence Structure

Complete sentences, fragments, run-ons, and parallel structure

Fragments in Clinical Documentation

A sentence fragment is an incomplete sentence — it is missing a subject, a verb, or both, or it is a dependent clause without an independent clause attached. Fragments are common errors in nursing documentation. Example fragment: 'Administered pain medication and documented response.' This is a fragment — there is no subject. Correct: 'The nurse administered pain medication and documented the response.' On the HESI A2 and TEAS, fragment questions typically ask you to identify which option is a complete sentence or to correct the error in a given sentence.

Sentence Fragments — Missing a Required Element

Fragment: "Because the patient was in pain." (dependent clause alone)

Complete: "Because the patient was in pain, the nurse administered morphine."

Fragment: "Assessed vital signs every hour." (no subject)

Complete: "The nurse assessed vital signs every hour."

Run-On Sentences — Independent Clauses Improperly Joined

Fused: "The patient was febrile the nurse called the physician."

Fix 1 (period): "The patient was febrile. The nurse called the physician."

Fix 2 (semicolon): "The patient was febrile; the nurse called the physician."

Fix 3 (conjunction): "The patient was febrile, so the nurse called the physician."

Parallel Structure — Matching Form in Lists and Comparisons

Not parallel: "The nurse will assess the patient, provide teaching, and documentation should be completed."

Parallel: "The nurse will assess the patient, provide teaching, and complete documentation."

In a list, all elements must use the same grammatical form. Here, all three should be verbs in the same tense: assess, provide, complete.

Sentence Structure — Self-Check

1/2

Which of the following is a complete sentence?

Subject-Verb Agreement

The verb must match its subject — not the words between them

Subject-Verb Agreement Rules

Subject-verb agreement means the verb must match the number (singular or plural) of its subject. Common errors: (1) Words between subject and verb: 'The nurse, along with the two aides, [is/are] responsible.' — the subject is 'nurse' (singular), so 'is' is correct. (2) Indefinite pronouns: everyone, someone, anyone, nobody = singular. 'Everyone on the unit is required to complete the training.' (3) Compound subjects with 'and' = plural: 'The doctor and the nurse are consulting.' (4) Either/or and neither/nor — verb agrees with the closest noun: 'Neither the nurses nor the doctor is available.'

The 7 Most-Tested Agreement Rules

Words between subject and verb do not change agreement

'The patient, along with her family members, is ready for discharge.' Subject = patient (singular) → is

Indefinite pronouns are singular

Everyone, someone, anyone, nobody, each, either, neither → singular verb. 'Each of the nurses is responsible.'

Compound subjects with 'and' = plural

'The doctor and the nurse are reviewing the chart together.'

Either/or, neither/nor → agree with closest noun

'Neither the nurses nor the physician is available.' 'Neither the physician nor the nurses are available.'

Collective nouns = singular in US English

'The team is presenting its findings.' (team acts as one unit)

Titles and works = singular

'Fundamentals of Nursing is a required text.'

Relative pronouns (who, that, which) = agree with antecedent

'The nurses who work nights are exhausted.' — plural. 'The nurse who works nights is exhausted.' — singular

Subject-Verb Agreement — Self-Check

1/3

Choose the correct verb: 'The nurse, together with three nursing students, ___ the procedure.'

Punctuation and Mechanics

Commas, semicolons, apostrophes, and capitalization in clinical writing

Punctuation Core Rules

Commas have six core rules tested on nursing entrance exams: (1) Before coordinating conjunctions joining independent clauses (FANBOYS): for, and, nor, but, or, yet, so. (2) After introductory words/phrases: 'However, the patient refused medication.' (3) Around non-essential clauses: 'The patient, who had a fall risk, was placed on bed alarm.' (4) In a series of three or more items. (5) Between coordinate adjectives modifying the same noun: 'a thorough, systematic assessment.' (6) With direct address: 'Dr. Smith, the lab results are ready.' Semicolons join two independent clauses without a coordinating conjunction: 'The patient's pain was 8/10; the nurse administered morphine.'

Punctuation Rules — With Healthcare Examples

Punctuation and Mechanics — Self-Check

1/3

Which sentence uses the apostrophe correctly?

Common Grammar Errors on Nursing Entrance Exams

Modifiers, pronoun reference, word choice, and double negatives

Misplaced & Dangling Modifiers

Misplaced modifier (modifier is in the wrong position):

"The nurse gave the medication to the patient who was in pain quickly." (Did the patient receive it quickly, or was the patient in pain quickly?)

✓ "The nurse quickly gave the medication to the patient who was in pain."

Dangling modifier (nothing in the sentence for it to modify):

"Reviewing the chart, the diagnosis was unclear." (Who was reviewing? Not the diagnosis.)

✓ "Reviewing the chart, the nurse found the diagnosis unclear."

Pronoun Reference Errors

"When the nurse spoke to the physician, she was exhausted." (Who was exhausted — the nurse or the physician?)

✓ "The nurse, who was exhausted, spoke to the physician." OR "The exhausted nurse spoke to the physician."

Every pronoun must have one clear, unambiguous antecedent.

Double Negatives

"The patient does not have no allergies." (Two negatives = positive, making this mean the patient has allergies)

✓ "The patient has no allergies." OR "The patient does not have any allergies."

Negative words: no, not, never, nothing, nobody, nowhere, neither, scarcely, barely, hardly. Use only one in a clause.

Commonly Confused Words in Healthcare Writing

affect / effect: affect = verb (to influence); effect = noun (the result)

its / it's: its = possessive; it's = it is

their / there / they're: their = possessive; there = location; they're = they are

principal / principle: principal = main/person; principle = rule/value

then / than: then = time sequence; than = comparison

who / whom: who = subject; whom = object (use him test: if him fits, use whom)

ESL & International Learner: Grammar Patterns in Nursing Documentation

English grammar rules that differ from most other world languages

English grammar has several features that differ significantly from French, Spanish, Filipino, Hindi, Mandarin, and other languages spoken by internationally educated nurses. This lesson targets the grammar patterns that most frequently cause errors for ESL learners on the HESI A2 Grammar section and in clinical documentation.

Articles: a / an / the — The Most Common ESL Error

Indefinite article (a/an): Use for a non-specific item mentioned for the first time. “A patient was admitted.” Use ‘an’ before a vowel sound: “an IV line,” “an hour,” “an RN.”

Definite article (the): Use when the item is specific or previously mentioned. “The patient (the one we’re talking about) was admitted. The nurse assessed the patient.”

No article needed: General concepts, abstract nouns, plural non-specific nouns. “Nurses use evidence-based practice.” NOT “The nurses use the evidence-based practice.”

Clinical documentation example: “The patient reported a pain level of 8/10 in the right knee. An analgesic was administered.”

Verb Tense in Clinical Documentation — Always Simple Past

Clinical notes use simple past tense for actions that already occurred: “The nurse assessed vital signs at 0800. The patient reported chest pain. Oxygen was applied at 2L via nasal cannula.”

Common ESL error: Mixing tenses. “The nurse assess vital signs and documents the findings.” ✗

Correct: “The nurse assessed vital signs and documented the findings.” ✓

Present tense is used for: standing orders, policies, current status. “Patient is currently NPO. The policy states that...”

Countable vs Uncountable Nouns in Healthcare English

Uncountable (no plural): equipment, information, advice, research, evidence, fluid, medication (as a general concept). “The patient needs information about the medication.” NOT “informations” or “meditations” [sic].

Countable (can be plural): medication (a specific pill), a finding, an intervention, a symptom, a diagnosis. “The nurse noted three findings during assessment.”

Tricky pair: “Research shows...” (uncountable — never “researches”). “Studies show...” (countable — can be plural).

Prepositions in Clinical Phrases — Cannot Always Be Translated Directly

complain OF pain
NOT complain about / from pain

allergic TO penicillin
NOT allergic from/with

dependent ON oxygen
NOT dependent from/of

at risk FOR falls
NOT at risk of falls (clinical English)

admitted TO the hospital
NOT admitted in

NPO AFTER midnight
NOT from midnight

pain ON a scale OF 1-10
NOT on a scale from

administer BY mouth / IV
NOT administer through

ESL Grammar Patterns — Self-Check

1/3

Which sentence uses correct article placement for clinical documentation?

English Grammar — Comprehensive HESI A2 / TEAS Practice

1/5

Choose the sentence with the correct modifier placement:

Pre-nursing comprehensive review

1/20

Which organelle contains its own DNA and is inherited exclusively from the mother?