Bowtie Item

Definition

A Bowtie item is a Next-Generation NCLEX (NGN) question format that visually resembles a bowtie: a central condition/problem is identified, with two potential causes ('because of') on the left and two nursing actions ('the nurse should') on the right. It tests all six steps of the Clinical Judgment Measurement Model (CJMM) in a single item.

Structure

• Center: The condition the client is most likely experiencing (prioritized hypothesis).
• Left (two): Supporting cues or reasons (analyze cues).
• Right (two): Priority nursing actions (take action).

Scoring

Uses a +/- partial credit scoring rule. You gain points for correct selections and lose points for incorrect ones, with a minimum of zero. Choose only the most defensible options.

Strategy

Identify the central problem first, then work outward. Avoid selecting too many options; each side typically has exactly two correct answers.

NCLEX Relevance

A signature NGN format, highly weighted on the 2024 to 2026 exam. Commonly appears as a standalone clinical judgment item or as the final item in a case study.