0/1 scoring · 30 questions in 6 sets
NCLEX Bow-Tie Questions: Examples and Practice
NCLEX bow-tie questions with worked examples and rationales: pick the condition, 2 actions and 2 parameters to monitor. Sets 1 and 2 are free, with no sign-up.
The format
What is a Bow-Tie question on the NCLEX?
Bow-tie questions are standalone Next Generation NCLEX nursing questions shaped like a bow tie. You drag in the condition the client is most likely experiencing (center), 2 actions the nurse should take (left), and 2 parameters to monitor (right).
They test the whole clinical judgment chain in one screen.
Practice sets
30 Bow‑Tie questions in 6 sets
Each set covers one clinical topic and opens in the NCLEX-style test interface. Submit each answer to see the correct answer and a rationale for every option. Your progress and score are saved in this browser.
Neuro
Maternity
Pediatrics
Mental Health
Sample question
Bow-tie question example with rationale
Open the sample to see the format on the exam screen, with the correct answer marked and the reason each option is right or wrong. To answer questions yourself, start a set above.
Sample question: answer and rationaleComplete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
The nurse in the long-term care facility is caring for an 88-year-old female client.
The nurse is reviewing the client's assessment data to prepare the client's plan of care.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Correct: orthostatic hypotension; actions: Teach the client to change position slowly., Request a pharmacist review of the medications.; parameters: dizziness on standing, lying and standing blood pressure.
Correct answer and rationale
Bow-Tie · 0/1 scoring
On standing, the systolic pressure fell from 134 to 108 and then 104 mm Hg, the diastolic pressure fell by more than 10 mm Hg, and the client felt lightheaded. A systolic drop of 20 mm Hg or more, a diastolic drop of 10 mm Hg or more, or dizziness on standing is orthostatic hypotension, and the nursing concern is a fall. The furosemide increase fits: medications that cause orthostatic blood pressure changes raise fall risk, so a pharmacist medication review is requested and the client is taught to get up slowly. Repeat lying and standing pressures and dizziness on standing show whether this is working. A restraint is used only when less restrictive measures have failed. A glucose of 96 mg/dL, a hemoglobin of 12.8 g/dL, and a symmetrical face, clear speech and equal grips do not fit hypoglycemia, anemia or a transient ischemic attack.
Takeaway: dizziness with a systolic drop of 20 mm Hg or more on standing is orthostatic hypotension; review the medications and teach slow position changes rather than reaching for a restraint.
Why each option is right or wrong
- orthostatic hypotension: Correct. The systolic pressure fell 26 mm Hg after 1 minute of standing and 30 mm Hg after 3 minutes, with lightheadedness that cleared on sitting.
- hypoglycemia: Incorrect. Low blood glucose is a value below 70 mg/dL; this reading is 96 mg/dL.
- transient ischemic attack: Incorrect. Sudden dizziness can be a sign of stroke, but the face is symmetrical, speech is clear and the grips are equal, and the dizziness comes only on standing.
- anemia: Incorrect. The hemoglobin of 12.8 g/dL is within the reference range for females.
- Teach the client to change position slowly.: Correct. Getting up slowly helps manage postural hypotension. The nurse helps the client stand and has her sit back down if she becomes dizzy.
- Request a pharmacist review of the medications.: Correct. For a client on medications that cause orthostatic blood pressure changes, a pharmacist review can lead to a recommendation to stop, substitute or lower a dose.
- Apply a vest restraint while the client is in the chair.: Incorrect. A restraint is used only when less restrictive measures have failed, and other measures have not yet been tried.
- Give 15 g of fast-acting carbohydrate.: Incorrect. Fast-acting carbohydrate treats a glucose below 70 mg/dL; this glucose is 96 mg/dL.
- Activate the stroke response team.: Incorrect. The dizziness comes only on standing, with a fall in blood pressure, and there is no face, arm or speech deficit to suggest a stroke.
- lying and standing blood pressure: Correct. Repeating the lying and standing readings shows whether the drop on standing is getting smaller.
- dizziness on standing: Correct. Lightheadedness or dizziness on standing is one of the abnormal findings and signals the risk of a fall.
- blood glucose: Incorrect. Glucose is followed for hypoglycemia, and this reading is within range.
- facial symmetry: Incorrect. Facial droop is checked when a stroke or transient ischemic attack is suspected.
- hemoglobin level: Incorrect. Hemoglobin is followed for anemia, and this value is within range.
Sources
- CDC STEADI: Measuring Orthostatic Blood Pressure
- Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls
- Open RN Nursing Fundamentals 2e, 5.7 Restraints
- 42 CFR 482.13 Condition of participation: Patient's rights (restraint and seclusion)
- DailyMed: Furosemide injection label
- Open RN Nursing Pharmacology, 6.9 Diuretics (LibreTexts mirror)
- CDC: Low Blood Sugar (Hypoglycemia)
- CDC: Diabetes Testing
- CDC: Signs and Symptoms of Stroke
- StatPearls: Normal and Abnormal Complete Blood Count With Differential
Scoring
How Bow-Tie questions are scored
Always worth 5 points: 1 for the condition, 1 for each correct action and 1 for each correct parameter (0/1 scoring). Actions can go in either action box, and parameters in either parameter box.
Scoring rules: NCSBN, Next Generation NCLEX. Last reviewed October 13, 2026.
How to answer Bow-Tie questions
- Decide the condition first from the chart cues. The actions and parameters should follow from it.
- Choose parameters that would show whether your actions are working.
- Some action choices are correct for a different condition. They are placed there to catch a wrong diagnosis.
FAQ
Bow-Tie questions: FAQ
What is a bow-tie question on the NCLEX?
Are bow-tie questions hard?
How do you answer a bow-tie question?
How many points is an NCLEX bow-tie question worth?
Does the order of the two actions matter?
Keep practicing
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