The National Council of State Boards of Nursing introduced the bow-tie stand-alone item type to test multiple phases of the Clinical Judgment Measurement Model.1 This 3-column, drop-and-drag item variation includes options of 5 actions, 4 potential conditions, and 5 parameters. After reviewing clinical information, candidates select the condition the client is most likely experiencing, 2 actions to take to address the condition, and 2 parameters to monitor to assess a client's progress. Used for teaching purposes, the process can be reversed so that students create the options to the same questions for a clinical scenario (see Supplemental Digital Content, Sample Reverse Bow-Tie, available at: http://links.lww.com/NE/B134). The simplest variation of a reverse bow-tie requires a student to provide correct responses for the condition the client is most likely experiencing, 2 actions to take, and 2 parameters to monitor. To further develop analytic skills, faculty can assign students to differentiate the most likely condition from 3 other potential conditions. Students complete the entire bow-tie grid by listing the addition conditions, and 1 action to take and 1 parameter to monitor for each. Selection of parameters and actions for the addition conditions should not be the ones indicated for the correct condition. Reverse bow-ties can be used as preclass assignments or as an assessment of learning following a case study classroom discussion.

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