Starting in April 2023, the NCLEX has introduced a revised format along with new question types. The Bowtie item is among the new question types featured on the new Next Generation NCLEX (NGN).
Bowtie items present a branching logic diagram with a main problem in the center and various possible outcomes on either side (like a bowtie).
Based on the information presented in the bowtie diagram, the test-taker must select the most appropriate action or intervention from a list of options.
What’s a Bowtie Item?
A Bowtie item is a type of question that presents test-takers with a graphic representation of a clinical situation as a bowtie diagram. The bowtie diagram typically includes a central event or problem and various options for addressing the issue or preventing negative outcomes.

How to Answer a Bowtie Question on the Next Generation NCLEX (NGN)
To answer these Bowtie questions, test-takers will need to carefully review the presented diagram and consider the possible outcomes on either side. They must then select the most appropriate action or intervention that will help achieve the desired outcome or prevent an adverse outcome.
You have to correctly drag and drop an item onto a series of targets within the bowtie diagram.
It’s important to note that Bowtie questions can be challenging. However, proper preparation and practice can help nursing test-takers develop the skills needed to answer these types of questions effectively on the NGN.
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