NGN Bow-Tie Item: Worked Walkthrough
Step-by-step walkthrough of a bow-tie NGN item with a sepsis scenario.
Bow-tie items are visually striking and feel intimidating the first time. They're not actually harder, they're just a different layout. Here's a worked example.
The layout
Center oval: 'The client is most likely experiencing _____'. Left wings: 2 conditions to drag (choose from 4-6). Right wings: 4 actions to drag (choose from 6-8). Bottom: 2 parameters (choose from 4).
Example scenario
65-year-old post-op day 2 with fever 102°F, BP 88/52, HR 122, RR 28, lactate 4.2, WBC 18K, foley with cloudy urine. Confused, mottled extremities.
Step 1: identify the condition
Combine signs, fever, tachycardia, hypotension, lactate, leukocytosis, mental status. Sepsis (likely septic shock given hypotension).
Step 2: pick the 2 conditions to address
From a list like: hypertension, septic shock, hypovolemia, DKA, MI. Pick septic shock + secondary (e.g., suspected UTI source).
Step 3: pick the 4 actions
From a list: fluid bolus 30 mL/kg, broad-spectrum antibiotics, blood cultures, vasopressor if no response, give insulin, restrict fluids. Pick: fluid bolus, blood cultures, broad-spectrum antibiotics, vasopressor if no response.
Step 4: pick the 2 parameters to monitor
From a list: lactate, BP/MAP, glucose, ABG. Pick: lactate, BP/MAP (sepsis tracking).
Frequently asked
What if I'm not sure of one wing?
Make best guess, partial credit means you don't lose all points for one missed item.
Time per bow-tie?
2-3 minutes. Worth more than standard items.
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