How to Answer a Bowtie NGN NCLEX Question

Bowtie NGN NCLEX questions are a common type of new NGN stand alone question. They include several parts of the nursing process and are a great way to test your knowledge and clinical nursing judgment.

The main things to know about a bowtie question are:

• includes a clinical scenario either presented as a paragraph or notes
• has a total of 5 answers
• you will not get any points taken off if you choose a wrong answer
• you get partial credit 🙂

A bowtie question looks like this:

If you want to know how to answer a bowtie NGN NCLEX question, you have to figure out 3 things:

1. what condition is this client most likely experiencing?
2. what are 2 actions you would do to help?
3. what are 2 assessments you’d do to monitor the client?

I suggest that as you read the Nurses’ Notes, you try to pick out the things that seem bad/weird/abnormal. Then focus on that content to answer the question.

What do you think this client is most likely experiencing?

The assessment data I thought abnormal was: an irregular heart rhythm, a “racing heartbeat”, “feeling faint”, and a high heart rate of 142. Right away, you can figure out that this client is having a cardiac issue. So the middle answer has to be atrial fibrillation or ventricular tachycardia.

Atrial fibrillation

Ventricular tachycardia

If the client has the second rhythm (ventricular tachycardia), they are on their way to becoming dead and are probably unresponsive. You can eliminate that answer. The answer is atrial fibrillation. Many clients with atrial fibrillation report a racing heartbeat. As you can see, atrial fibrillation is very irregular, which is one of the assessment findings in the Nurses’ Notes.

If you’re not sure how to read the EKG strips, you can read this simple blog post about EKGs or check out my NCLEX Nugget Pages book.

EKGs page from the Nuggets book

Now that you know it’s atrial fibrillation, what 2 actions would you take to help this patient?

You’re choices are:

1. Prepare client for immediate cardioversion
2. Perform a cardiac stress test
3. 12 lead EKG
4. Monitor airflow via incentive spirometry
5. Prepare for verapamil continuous IV infusion

Obviously you have to know what procedures, tests, and meds are for. You have to know nursing content!

1. Prepare client for cardioversion: this is a very invasive procedure that shocks the heart back into a normal sinus rhythm. This is a good answer, but can be an “extreme” answers. I usually avoid answers that sound very invasive or “extreme”, unless there’s nothing else I can do. Eliminate.
2. Perform a cardiac stress test (see pic): this is when the client takes meds or gets on a treadmill to “stress” the heart. Does this sound like a good idea knowing that the client already feels faint? BAD answer. Eliminate.
3. 12 lead EKG: this is a test where you can see the rhythm of the heart on graph paper. This will confirm what type of dysrhythmia the client is having.
4. Monitor airflow via incentive spirometry: this is a little contraption that shows how deep of breaths the client can take. This is a great answer if the client has a pneumonia; which they don’t. Eliminate.
5. Prepare for verapamil continuous IV infusion: Oh no! What med is this? At the very basic level, know what the med is for. It’s a calcium channel blocker that will help put the client back into a normal sinus rhythm. Great answer!

The guy below is getting a cardiac stress test. This would be a VERY bad idea for a client with high heart rate and feeling faint. But I wanted to show you what it looked like!

The last step in how to answer a bowtie NGN question is to look at the 5 assessments you’d choose to monitor the client and only choose 2 answers. Your choices are:

1. Troponin levels
2. Heart rate
3. Chest x-ray
4. Neurological status
5. Peripheral pulses

Don’t all these answers look good! Remember to keep the medical problem in mind.

1. Troponin levels tell you about what? If the client is having a myocardial infarction. It’s not a bad answer, but the client isn’t having symptoms of an MI. Eliminate.
2. Heart rate: the client does have a high heart rate, so this would be a very safe answer. You want to see the heart rate decrease.
3. Chest x-ray: what are chest x-rays for? Typically this is done to look for a pneumonia or size of the heart. It’s not a bad answer, but not very specific to a cardiac issue. Eliminate.
4. Neurological status: the client did say he was feeling faint. Neuro status would tell you about oxygen level. I like this answer! And it’s safe!
5. Peripheral pulses: this is not an typical assessment for atrial fibrillation. Usually you feel pulses for clients with edema or after they’ve had a cardiac catherization procedure. Eliminate.

Answers

The final answers are:

1. atrial fibrillation
2. 12 lead ekg
3. prepare for verapamil infusion
4. heart rate
5. neurological status

How did you do?

Watch the video to hear me explain how to answer a bowtie NGN NCLEX question.

If you need NCLEX tutoring go to thenclextutor.com! We have a whole team of NCLEX tutors. If you need to review content, check out the NCLEX Nursing Nugget Pages book.