Enterprise Portal: Tips for Bowtie Questions

This feature is currently in limited release. Please reach out to your Customer Success Manager with any questions.

Bowtie items address all six steps of the Clinical Judgment Measurement Model at one time. The exam-taker reads a scenario, recognizes cues, analyzes cues, and generates solutions. Then, the exam-taker completes the bowtie layout to determine the most likely condition that the client in the scenario is experiencing (Generate Hypotheses), the appropriate actions to take (Take Action), and the parameters to monitor (Evaluate Outcomes). 

The solution looks like a bowtie with two “Actions to Take” on the left, two “Parameters to Monitor” on the right, and a single “Condition Mostly-Likely Experiencing” response in the middle. 

Note: The above information and example are from Next Generation NCLEX News, Spring 2021.

Portal Procedures


Create Bowtie Question Type


  1. Create a question, and select Bowtie.

Note: For more information, see: Enterprise Portal: Basic Steps to Create and Edit Questions

  1. Optional: Add Question Title
  • You might find it useful to enter a label that describes this question. If you leave this field blank, ExamSoft will create a title by using the first 60 characters of the Question stem. 
  1. Optional: Add Case Study
  2. Enter the Question with the text you want to appear above the bowtie layout, and include any instructional text to help the exam-takers understand how to complete the bowtie interaction.
  • For example: "Complete the diagram using the choices below to specify what condition the client is most-likely experiencing. According to these findings, choose 2 actions to take, the potential condition, and 2 parameters to monitor.”
  1. Label each answer column.
  • By default, the Answer Choice columns are labeled: Action to Take, Potential Condition, Parameters to Monitor. These labels can be changed, and the limit is 50 characters per label. The preview of the bowtie is dynamic and will change as you select the correct answers.
  1. Create the answer choices for each column.
  • By default, there are four answers listed per column. You can create additional answer choices by selecting the Add answer choice button at the bottom of each column.
    1. Each Answer Choice column can have up to 26 answer options. The minimum number of options in each category is three, two, three: one choice more than the required number of responses.  
    2. The Answer Choices boxes can contain up to 150 characters.
  1. Select the correct answer by clicking the checkmark to the right of each answer option. 
    1. In the Action to Take column, two correct answers must be selected.
    2. In the Potential Condition column, only one correct answer can be selected.
    3. In the Parameter to Monitor column, two correct answers must be selected.
    4. Delete any answers by clicking the Trash icon.
Incorrect with Warning: No correct answers selected
Incorrect: No correct answers selected for last column
  1. Click Save; then, add your newly-created question to an assessment.

Important Assessment Settings

  • Backward Navigation: Disabled 
  • Require Answer: Enabled

The exam taker must provide the answers for each column in the bowtie before moving on. 

If these settings are enabled: Exam-takers will see this message at the beginning of the exam: “This exam does not allow backward navigation. Please make sure you answer each question before moving on to the next question.”

  • Bowtie Incomplete: Next button unavailable
  • Bowtie Complete: Next button available


Every bowtie question has a total of 5 correct selections. Students receive an equal percentage of the total number of points for each correct selection. For example, if the total number of points awarded for a bowtie question is 1 point, each select is worth .20 points. 


In the example below, the student selected 4 of 5 answers correctly and earned .8/1 points. 

You can change the total weight of the bowtie question by updating the points column to the maximum number of correct answers.


The image below is the class report for the attached student results.

Student View

Bowtie Question - Student.gif

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