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English Grammar and Usage

The grammar section checks your command of standard written English, including sentence structure, agreement, and punctuation. Clear writing matters in nursing because errors in charts can cause confusion. This chapter reviews the rules most often tested and shows how to spot common mistakes.

Subject-Verb Agreement

A verb must agree in number with its subject, which can be tricky when phrases come between them. Compound subjects and words like each or neither follow special rules. Reading the true subject carefully prevents errors.

Match number

Singular subjects take singular verbs and plural subjects take plural verbs.

Ignore phrases between subject and verb

In 'each of the students,' the subject is 'each,' which is singular and takes 'has.'

Compound subjects with and

Two subjects joined by 'and' are plural and take a plural verb, as in 'the nurse and the doctor were.'

Neither/nor agreement

With 'neither/nor' or 'either/or,' the verb agrees with the subject closer to it.

Pronoun Usage

Pronouns must match their antecedents and take the correct case as subject or object. Confusing subject and object pronouns is a frequent error. Possessive pronouns and contractions are also commonly tested.

Subject versus object pronouns

Use subject pronouns like 'he and I' as subjects and object pronouns like 'me' after prepositions.

Its versus it's

'Its' shows possession, while 'it's' is a contraction of 'it is.'

Their, there, they're

'Their' is possessive, 'there' refers to place, and 'they're' means 'they are.'

Avoid myself as a subject or object

Use 'me' or 'I' instead of 'myself' unless the sentence already names the same person as the subject.

Punctuation

Correct punctuation clarifies meaning by grouping words and separating ideas. Commas, semicolons, colons, and apostrophes each have specific uses. Misplaced punctuation can create run-ons or change meaning.

Comma after an introductory phrase

Place a comma after an introductory word or phrase, as in 'Before the exam, we reviewed our notes.'

Semicolon joins independent clauses

Use a semicolon to link two complete sentences that are closely related, avoiding a comma splice.

Colon introduces a list

Use a colon after a complete sentence to introduce a list, then separate items with commas.

Apostrophes for possession

Add apostrophe plus s for a singular possessive, as in 'the patient's chart.'

Sentence Structure

A complete sentence needs a subject, a verb, and a complete thought. Fragments and run-ons are common structural errors on the exam. Parallel structure keeps lists balanced and clear.

Avoid fragments

Make sure each sentence has a subject and verb and expresses a full thought, not just a phrase.

Fix run-ons

Separate two independent clauses with a period, a semicolon, or a comma plus a conjunction.

Keep parallel structure

Items in a list should share the same grammatical form, such as reading, writing, and jogging.

Place modifiers carefully

Put descriptive words and phrases near the words they modify to avoid confusion.

Word Choice and Spelling

Choosing the right word and spelling it correctly are basic parts of strong writing. Homophones and commonly misspelled words appear often. Adjectives and adverbs must be used in their proper roles.

Distinguish homophones

Choose the correct word among sound-alikes such as their, there, and they're based on meaning.

Adjective versus adverb

Use adjectives to describe nouns and adverbs, often ending in -ly, to describe verbs, as in 'spoke quietly.'

Comparatives and superlatives

Use the comparative form like 'better' for two items and the superlative like 'best' for three or more.

Watch tricky spellings

Apply rules such as 'i before e except after c' to spell words like 'receive' correctly.

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Last updated: July 2026