Subject-Verb and Pronoun Agreement

At the atomic level of English grammar, agreement is a matter of matching variables. The engine of any sentence is its subject (the actor) and its verb (the action).

The Core Rule: A singular subject requires a singular verb, and a plural subject requires a plural verb.

• Singular: The nurse (subject) checks (verb) the monitor.
• Plural: The nurses (subject) check (verb) the monitor.

This matching principle extends to pronouns. An antecedent is the specific noun or pronoun that a pronoun replaces. If we say, "The patient left his chart," patient is the antecedent of his.

To maintain structural integrity:

1. A pronoun must agree with an antecedent in number (singular or plural).
2. A pronoun must agree with an antecedent in gender (masculine, feminine, or neuter).
3. A pronoun must agree with an antecedent in person (first, second, or third person).

Furthermore, a pronoun cannot float aimlessly; a pronoun must have a clear and unmistakable antecedent. If a chart reads, "The doctor told the technician that he needed to sign the form," who is "he"? The doctor or the technician? This ambiguity is grammatically and professionally unacceptable.

Similarly, shifting person within a sentence creates a pronoun agreement error. You cannot start in the third person and shift to the second person:

• Incorrect: When a nursing student studies anatomy, you must memorize terminology.
• Correct: When a nursing student studies anatomy, he or she must memorize terminology.

In a busy emergency department, a triage nurse must identify a patient's primary complaint despite a barrage of distracting secondary symptoms. Sentence analysis requires the exact same focus.

Source: 13049 2012 Article 483 Fig2 HTML by Svenurban, CC BY-SA 4.0.

Words appearing between a subject and a verb do not change the number of the subject. The most common "distractors" are prepositional phrases.

Rule: Prepositional phrases separating a subject from a verb do not affect subject-verb agreement.

• Example: The dosage of the four aggressive antibiotics is carefully monitored.
• Why? "Of the four aggressive antibiotics" is a prepositional phrase. The true subject is the singular dosage, so the verb must be the singular is.

Inverted Structures

English typically follows a Subject-Verb-Object order. But occasionally, the structure is inverted, hiding the subject behind the verb.

First, the words 'here' and 'there' are never the true subject of a sentence. In sentences beginning with 'here' or 'there', the true subject follows the verb.

• Example: There are three new patients in the waiting room. (The plural subject patients dictates the plural verb are).

Second, in an interrogative sentence (a question), the subject frequently follows the verb.

• Example: Where is the defibrillator? (The singular subject defibrillator dictates the singular verb is).

When subjects or antecedents are joined by conjunctions, the rules of mathematics apply.

The "And" Operator (Addition)

When you combine two items with "and," you are compounding them. Therefore, subjects joined by the conjunction 'and' require a plural verb.

• Example: The physician and the pharmacist review the contraindications.

Because the antecedent rule mirrors the subject-verb rule, two or more singular antecedents joined by 'and' require a plural pronoun.

• Example: The physician and the pharmacist review their notes.

The "Or" / "Nor" Operators (Proximity)

"Or" and "nor" do not add subjects together; they offer alternatives. In these cases, we use the Rule of Proximity.

A compound subject joined by 'or' requires the verb to agree with the subject closest to the verb. A compound subject joined by 'nor' requires the verb to agree with the subject closest to the verb.

• Example: Neither the nurses nor the charge nurse is available. (The singular charge nurse is closest to the verb).
• Example: Neither the charge nurse nor the nurses are available. (The plural nurses is closest to the verb).

This same proximity rule applies to pronouns: Two or more antecedents joined by 'or' (or 'nor') require the pronoun to agree with the antecedent closest to the pronoun.

• Example: Neither the doctor nor the nurses took their breaks.

The "Every" and "Each" Overrides

There are highly specific modifiers that override the "and" rule.

• The word 'every' preceding a compound subject requires a singular verb. (e.g., Every doctor and nurse is required to wash hands.)
• The word 'each' preceding a compound subject joined by 'and' requires a singular verb. (e.g., Each syringe and vial is inventoried.)

First- and second-person pronouns carry rigid, historically entrenched behaviors that defy simple intuition.

• The pronoun 'you' always takes a plural verb regardless of whether the pronoun refers to one person or multiple people. Even if you are speaking to a single patient, you say, "You are going to be fine," never "You is going to be fine."
• The pronoun 'I' takes a plural verb in the present tense except for the verb 'am'. We say "I walk" (plural verb form) and "I have" (plural verb form), not "I walks" or "I has." The lone exception is the singular "I am."

Indefinite pronouns refer to nonspecific persons or things. Because they are nonspecific, they cause immense trouble on standardized exams. Memorize these distinct categories.

Category A: The Strict Singulars

Certain indefinite pronouns refer to individual items within a group. Therefore, they are grammatically singular.

• Indefinite pronouns ending in '-one' always take singular verbs (e.g., anyone, everyone, someone, no one).
• Indefinite pronouns ending in '-body' always take singular verbs (e.g., anybody, everybody, somebody, nobody).
• Indefinite pronouns ending in '-thing' always take singular verbs (e.g., anything, everything, something, nothing).
• The indefinite pronouns 'each', 'either', and 'neither' always take singular verbs.

Example: Everyone in the ward is resting. Neither of the treatments is effective.

CRITICAL HESI RULE FOR PRONOUN REFERENTS: Because these indefinite pronouns are singular, singular indefinite pronouns require singular personal pronouns as referents. In everyday conversation, people often say, "Everyone has their chart." On the HESI A2, this is incorrect. Singular indefinite pronouns require the singular pronouns 'his', 'her', or 'its' instead of the plural pronoun 'their' in formal grammar.

• HESI Correct: Everyone has his or her chart.

Category B: The Strict Plurals

The indefinite pronouns 'both', 'few', 'many', and 'several' always take plural verbs. Consequently, plural indefinite pronouns require plural personal pronouns as referents.

• Example: Several of the vials were dropped, and they shattered.

Category C: The Chameleons

Some indefinite pronouns change their number depending on the context. The number of indefinite pronouns like 'all', 'any', 'most', 'none', and 'some' is determined by the object of the following prepositional phrase.

• Example (Singular): Most of the water is contaminated. (Water is singular).
• Example (Plural): Most of the tools are sterilized. (Tools is plural).

Percentages

Fractions and percentages behave exactly like the chameleon indefinite pronouns.

• Percent expressions take a singular verb when modifying a singular noun. (e.g., Fifty percent of the clinic is renovated.)
• Percent expressions take a plural verb when modifying a plural noun. (e.g., Fifty percent of the patients are discharged.)

Language allows us to group multiple individuals into a single conceptual entity. The words 'team', 'jury', 'committee', and 'family' are examples of collective nouns.

Whether they take a singular or plural verb depends entirely on how the group is behaving.

• Collective nouns referring to a group as a single unit take a singular verb. Furthermore, a collective noun acting as a single unit requires a singular pronoun.
  • Example: The surgical team has completed its operation. (Acting together as one unit).
• Collective nouns referring to group members acting individually take a plural verb.
  • Example: The jury are arguing among themselves. (Acting as individual, separate people).

Standardized tests love to exploit nouns that look plural but act singular, and vice-versa.

Singulars Disguised as Plurals

Many nouns ending in 's' are actually singular concepts.

• Certain nouns ending in '-s' like 'mathematics' or 'news' require singular verbs. (e.g., The news is grim.)
• The noun 'measles' requires a singular verb.
• The noun 'physics' requires a singular verb.

Furthermore, measurements that represent a single, cohesive block of something are treated as singular.

• Nouns plural in form representing a single unit of distance require a singular verb. (e.g., Ten miles is a long walk.)
• Nouns plural in form representing a single unit of money require a singular verb. (e.g., $500 is the standard deductible.)
• Nouns plural in form representing a single unit of time require a singular verb. (e.g., Four hours is the length of the exam.)

Lastly, titles of books, movies, or organizations take singular verbs despite ending in a plural form. (e.g., The Elements of Style is an essential book.)

Source: Measles Illustration IMG by Chidiebere Ibe, CC BY-SA 4.0.

Plurals Disguised as Single Items

Conversely, objects composed of two attached parts are treated as plural unless preceded by the phrase "pair of."

• The noun 'scissors' requires a plural verb. (e.g., The scissors are sharp.)
• The noun 'pants' requires a plural verb. (e.g., The scrub pants are blue.)

Source: Standard household scissors by Doggerelblogger, CC BY-SA 4.0.

To close out our mastery of agreement, we must address three specific grammatical constructs that frequently appear on entrance exams.

"A Number" vs. "The Number"

Though they differ by only one word, these two phrases have opposite grammatical functions:

• The phrase 'a number of' requires a plural verb. It functions identically to "several" or "many." (e.g., A number of beds are empty.)
• The phrase 'the number of' requires a singular verb. Here, the subject is the singular mathematical concept of the "number." (e.g., The number of available beds is low.)

Verbals Used as Subjects

When an action is used as a noun, it forms a cohesive, singular concept.

• A gerund (an -ing verb acting as a noun) used as a subject requires a singular verb. (e.g., Diagnosing patients requires patience.)
• An infinitive phrase (to + verb) used as a subject requires a singular verb. (e.g., To save a life is the ultimate goal.)

Summary for the HESI A2

Do not rely merely on "what sounds right." The ear is trained by casual conversation, which is rife with agreement errors (like using "their" for "everyone"). When you sit for the exam, analyze the anatomy of the sentence mechanically. Locate the true subject. Strip away the intervening prepositional phrases. Identify if the subject is singular, plural, compound, or indefinite. Then, apply the corresponding law. Precision in grammar, just like precision in medicine, is not arbitrary; it is the guarantee of accuracy.

Source: Accuracy and precision by Pekaje at English Wikipedia, GFDL.