Legacy Portal: Tips for Bowtie Questions

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

Bowtie Question Type

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


Legacy Portal: Create Bowtie Question Type


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

  1. Create a question, and select Create Bowtie.


  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 a Case Study Artifact
  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: Actions 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.

  • You can also edit the Answer Choice(s) by selecting the pencil icon next to each column.

  1. Create the answer choices for each column.
  • By default, there are two answers listed per column. You can create additional answer choices by selecting the Add New Action to Take, Add New Potential Condition, and Add New Parameter to Monitor buttons 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 Choice boxes can contain up to 150 characters.
  1. Select the correct answer by select the Correct checkbox to the right of each answer option. 
    1. In the 2 Actions 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 2 Parameters to Monitor column, two correct answers must be selected.
    4. Delete any answers by clicking the red, circular delete icon.
Incorrect with Warning: No correct answers selected
Incorrect: No correct answers selected for the middle column (Potential Condition)
  1. Click Save.


  2. Click Approve; then, add your newly-created question to an assessment.

  3. Recommended: Assign one or more categories.
    1. For more information, see: Legacy Portal: Assign Categories to Questions

  4. Optional: Select other options, if needed.
      1. If the question involves an electronic health or medical record, you can upload an attachment or use the Case Study component of the question. For more information about attachments, see: Attachment Types and Requirements
      2. If there are multiple questions related to the same case, you can group the questions together after you add them 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.”



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. 


For example, if the student selected 4 of 5 answers correctly, they will earn .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.



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