TEAS English and Language Usage: the grammar, punctuation, and vocabulary rules to know
Written and reviewed by Rebecca Moore, MSN, RN, CEN · 3 min read · Updated October 2026
Short answer
TEAS English and Language Usage is 37 questions in 37 minutes, so about a minute each. ATI groups it into conventions of standard English (spelling, punctuation, sentence structure), knowledge of language (clarity, tone, paragraph organisation), and using vocabulary (word parts and the writing process). A short list of grammar rules covers most of the points available.
Conventions: punctuation and sentence structure
Conventions of standard English is 12 questions. The punctuation rules that do most of the work are commas after an introductory phrase, commas around extra information that could be removed, a comma before a conjunction such as and or but that joins two complete sentences, and a semicolon to join two complete sentences without a conjunction.
Sentence structure questions ask you to spot a run-on, a fragment, or a comma splice, and to recognise simple, compound, and complex sentences. Spelling questions favour commonly confused words, such as affect and effect, or their, there, and they're. Apostrophes are worth a quick review as well: an apostrophe shows possession or a missing letter, never a plural, and its without an apostrophe is the possessive form.
Knowledge of language: grammar for clarity
This part is 11 questions. Subject and verb must agree in number, even when a phrase sits between them: the list of supplies is, not are. A pronoun must agree with the noun it replaces and must clearly refer to one noun, not two. Verb tense should stay consistent unless the timing actually changes.
ATI also tests whether language suits its audience and purpose, so expect questions asking which version of a sentence is more formal or more appropriate for a professional note. Paragraph questions ask which sentence best introduces, supports, or concludes an idea, or which sentence does not belong. Read the whole paragraph before choosing, because the right answer depends on the sentences around it.
Vocabulary and the writing process
The remaining 10 questions cover using language and vocabulary to express ideas. A big part is working out word meaning from prefixes, roots, and suffixes: hyper means over, hypo means under, and the suffix itis means inflammation. The writing process questions ask about steps like planning, drafting, and revising.
Because the clock is tight, aim to answer the quick grammar items fast and bank time for the paragraph questions. Our free TEAS English practice questions explain the rule behind every answer, so each mistake points to the rule to review.
Common questions
How many questions are on the TEAS English section?
37 questions in 37 minutes on TEAS Version 7, with 4 of them unscored pretest items you cannot tell apart from the rest.
What grammar is on the TEAS?
Punctuation, sentence structure, subject and verb agreement, pronoun use, consistent tense, spelling of commonly confused words, formal versus informal language, and paragraph organisation.
Is vocabulary tested on the TEAS?
Yes, mainly through word parts and context. Knowing common medical prefixes, roots, and suffixes helps here and in the Reading section.