Free ATI TEAS 7 English & Language Usage guide

November 2026 - Spelling & Commonly Confused Words Study Guide

Expect commonly confused pairs and standard usage: their, there and they're; to, too and two; affect as a verb and effect as a noun; then for time and than for comparison. Each pair has a test that settles it in a second, which is worth far more than trying to remember the rule.

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Updated November 2026

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Conventions of standard English

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English & Language Usage guide Conventions of standard English · 12 scored questions 6 min read

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The pairs that appear most

Words	Meanings	Test
their / there / they're	Possessive / place / they are	Substitute "they are"; if not, ask whether ownership or location is meant
to / too / two	Direction or infinitive / also or excessive / the number	Substitute "also" or "excessively" for `too`
affect / effect	Verb: to influence / noun: a result	`Affect` is an Action; `Effect` is an End result
than / then	Comparison / time or sequence	`Then` and `time` both have an e
accept / except	To receive / excluding	Substitute "excluding" for `except`
principal / principle	Chief person or main / a rule or belief	The principal is your pal; a principle is a rule
lose / loose	To mislay / not tight	`Loose` rhymes with goose
advice / advise	Noun / verb	`Advise` sounds like a verb, with a z sound

Affect is occasionally a noun and effect occasionally a verb — "flat affect" in a mental health note, "to effect change" meaning to bring it about. Those are the exceptions, and on the TEAS the verb-noun rule is what is being tested unless the sentence clearly signals otherwise.

Confusions worth knowing for clinical writing

Lie / lay — you lie down yourself; you lay something down. The past tense of lie is lay, which is what makes the pair so difficult.
Fewer / less — fewer for things you can count (fewer patients), less for quantities you cannot (less fluid).
Its / it's — possessive against "it is". See the apostrophe topic.
Complement / compliment — one completes, the other praises.
Discreet / discrete — tactful, against separate and distinct.

Question 1 of 4

Which sentence is correct?

The medication had a noticeable affect on his blood pressure. The medication had a noticeable effect on his blood pressure. The medication affected a noticeable affect on his blood pressure. The medication effected a noticeable affect on his blood pressure.

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Correct answer: B. The medication had a noticeable effect on his blood pressure.

"A noticeable ___" needs a noun, and effect is the noun meaning result. Affect is the verb, so the first choice puts a verb where the grammar requires a noun.

Spelling rules that hold often enough to use

i before e except after c — believe, receive. Real exceptions exist: weird, seize, height, their.
Doubling — with a short vowel before a single final consonant, double it before adding a vowel ending: stop → stopping, refer → referred.
Silent e — drop it before a vowel ending, keep it before a consonant ending: hope → hoping, but hope → hopeful.
y to i — change y to i before most endings: carry → carried, happy → happiness.

Question 2 of 4

Choose the correct words: (Their / There / They're) reviewing the notes over (their / there / they're) before (their / there / they're) shift ends.

Their … there … they're They're … there … their There … their … they're They're … their … there

View the Answer and Explanation

Correct answer: B. They're … there … their

The first slot means "they are", the second refers to a place, and the third shows possession of the shift. Substituting "they are" into each slot in turn identifies the contraction, and asking whether ownership or location is meant separates the other two.

Applying a substitution test

Worked example

Choose: The new rota will (affect / effect) every shift, and the (affect / effect) on morale is already visible.

First blank: something is being done to the shifts, so a verb is needed.
Affect is the Action, so affect fits the first blank.
Second blank: "the ___ on morale" follows "the", so a noun is needed.
Effect is the End result, so effect fits the second.

The new rota will affect every shift, and the effect on morale is already visible. Testing whether the slot needs a verb or a noun resolves this pair every time.

Terms to know

Homophone: A word that sounds like another but is spelled differently and means something else.
Affect: Usually a verb: to influence.
Effect: Usually a noun: a result.
Than: Used for comparison.
Then: Used for time or sequence.
Fewer: Used for things that can be counted.
Less: Used for quantities that cannot be counted individually.

What the TEAS 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 word correctly completes the sentence?

Apply the test for that pair, and check whether the slot needs a noun or a verb.

Which sentence contains a spelling error?

Scan for confused pairs first; they are far more common on this exam than misspellings.

Fewer or less?

Fewer for countable things, less for uncountable quantities.

Question 3 of 4

Which sentence uses fewer and less correctly?

The ward had less patients and fewer paperwork this week. The ward had fewer patients and less paperwork this week. The ward had less patients and less paperwork this week. The ward had fewer patients and fewer paperwork this week.

View the Answer and Explanation

Correct answer: B. The ward had fewer patients and less paperwork this week.

Patients can be counted individually so they take fewer, while paperwork is a mass quantity and takes less. Applying the countable test to each noun separately gets this right every time.

Key points

Affect is the action; effect is the end result.
Than compares; then is about time.
Fewer for what you can count, less for what you cannot.
You lie down; you lay something down.
Test each pair by substitution rather than trying to recall a rule.

Question 4 of 4

Which sentence is spelled correctly?

She was refered to the specialist, who advised bed rest. She was referred to the specialist, who adviced bed rest. She was referred to the specialist, who advised bed rest. She was refered to the specialist, who adviced bed rest.

View the Answer and Explanation

Correct answer: C. She was referred to the specialist, who advised bed rest.

Refer has a short vowel before a single final consonant, so the r doubles before -ed, and advise is the verb while advice is the noun. Each wrong choice fails on one or both of those points.

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Which sentence is correct?

The medication had a noticeable affect on his blood pressure.
The medication had a noticeable effect on his blood pressure.
The medication affected a noticeable affect on his blood pressure.
The medication effected a noticeable affect on his blood pressure.

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November 2026 - Spelling & Commonly Confused Words Study Guide for nursing students in

The pairs that appear most

Confusions worth knowing for clinical writing

Question 1 of 4

Spelling rules that hold often enough to use

Question 2 of 4

Applying a substitution test

Terms to know

What the TEAS asks most

Question 3 of 4

Key points

Question 4 of 4

Knowledge Check Results