ATI Nursing Exam Notes: Bow-Tie Decision Framework, NGN Item Types, DVT Example, and Week 4 ATI Assignments

Exam context and workflow

• You are presented with a patient chart consisting of multiple tabs; read all information across tabs.
• From memory banks (learned knowledge), determine what condition the patient probably has.
• Follow the bow-tie decision structure:
  • Middle row: choose the potential condition from the provided options.
  • Top and bottom of the bow tie (the two actions): select two actions to take; order does not matter.
  • Last column: choose two parameters to monitor to assess whether the actions are working.
• This mirrors the nursing process:
  • Assess the patient
  • Identify a potential problem (nursing diagnosis)
  • Plan and implement two actions
  • Evaluate the effectiveness of those actions
• Scoring: this question is worth 5 points because you click on 5 items.
  • If you get any item wrong, you lose that portion of points.
  • Example: you might get 3/5 correct, i.e., 3 points earned out of 5.
• If you pick the wrong condition, you’ll likely miss on multiple parts (all five items), so understanding the condition is crucial.
• This is a multi-response item: there can be multiple correct options.

Conceptual example: Deep Vein Thrombosis (DVT) signs and symptoms

• DVT = a blood clot in the leg.
• Important to distinguish DVT from pulmonary embolism (PE): signs like dyspnea (shortness of breath) and hemoptysis (bloody sputum) are more associated with PE, not isolated DVT.
• Correct signs/symptoms for DVT (per the slide):
  • Tenderness
  • Warmth
  • Swelling
  • Redness
• Incorrect potential DVT indicators in the example: dyspnea, hemoptysis.
• Real-world context given by the presenter:
  • DVTs are common postpartum due to swelling; OB nurses monitor for clots.
  • Do not massage legs if a clot is suspected; improper massage or manipulation could dislodge a clot.
  • If a clot is suspected in the lungs, dyspnea and hemoptysis would be pertinent signs, but for DVT alone they are not the primary indicators.
• Visual/metaphor provided: a DVT is a “hot spot” and can feel like bumping the leg on a coffee table; this is a way to remember localized leg symptoms.
• Practical nursing advice tied to this example:
  • Do not massage the legs if DVT is suspected; follow protocol and likely use saline/fluids per unit policy.
  • Education for caregivers (“daddies”) about safety and warning signs.
• Partial-credit logic in multiple-response items:
  • If there are four correct answers and you pick four correct ones plus an extra incorrect one (e.g., add dyspnea), you lose points for the extra incorrect choice.
  • If there are two correct answers and you select all options, you may receive zero points because the extra selections are incorrect.
  • Therefore, you must weigh probabilities and avoid over-picking.

NGN (Next Generation NCLEX) question types and mechanics

• NGN items describe several different interaction styles used on the nursing exams.

Ordered response (NGN)

• Also described as an ordering task: you identify what you do first, second, etc.
• You drag items into the correct order to reflect sequence of care or steps.
• This is a direct reflection of critical-thinking and the nursing process timing.

Drag-and-drop (clothes) — two blanks

• In “drag and drop” variants (funny name: ‘clothes’): you have two or more blanks to fill.
• Drag options from the answer bank into the blanks.
• If there are two blanks, the order often does not matter for some variants; you can drag either option into either blank.
• For other drag-and-drop variants (e.g., drag items into specific blanks), the exact placement matters.

Drag-and-drop rationale

• A more precise drag-and-drop: you must pair a disease process or client condition with specific signs/symptoms as evidence.
• Steps: pick the condition, then drag the two or more signs/symptoms into the appropriate spaces to justify the diagnosis.

Drag-and-drop (fill-in) vs. drop-down items

• Drag-and-drop fill-in: two or more blanks; placement may require specificity depending on the prompt.
• Drop-down items: hover over a blank; a drop-down menu appears with options to click.
• Important: always fill in all blanks; do not leave blanks empty.

Highlight items

• In some questions, you must highlight findings that require immediate follow-up by the nurse.
• Each body system will have at least one significant finding to highlight.
• Caution against over-highlighting; highlight only the critical information, not everything.

Matrix grid vs. response matrix grid

• Matrix grid:
  • One column contains information; the other columns have boxes to check.
  • You place a check in the appropriate box per the instruction.
  • Rules are guided by the prompt; you typically select one box per row unless instructed otherwise.
• Response matrix grid:
  • This variant allows more than one correct option per row.
  • It may let you select multiple boxes per row.
  • Be mindful: some grids prevent selecting mutually exclusive options; selecting one may clear the other.
• Practical takeaway: read the instructions carefully; matrix grid tends to be single-answer per row, while response matrix grid allows multiple selections.

Practical implications and test-taking strategy

• Understand the nursing process framework (Assess → Diagnose/Plan/Implement → Evaluate).
• Master the bow-tie structure: identify the condition, select two actions, select two monitoring parameters.
• Build familiarity with common nursing terms and signs/symptoms for conditions like DVT/PE.
• Pay attention to which items are mutually exclusive in grid-type questions to avoid auto-clearing choices.
• Use partial-credit logic to optimize correct selections; avoid unnecessary extra picks that could reduce score.

Real-world relevance and professional context

• Emphasis on communication in nursing exams mirrors real-world importance of clear, accurate communication with patients and families.
• Week 4 ATI assignments focus on communication:
  • Module: Factors that affect communication with individuals and groups
  • Module: Therapeutic communication
• These topics underscore that effective communication is central to safe and effective nursing care.

Ethical, philosophical, and practical implications

• Safety-first approach: do not massage legs with potential DVT; follow clinical guidelines and institutional policies.
• Accurate recognition of signs/symptoms prevents misdiagnosis and ensures appropriate interventions.
• Respect for patient and family education, especially in OB/postpartum contexts where DVT risk is present.
• Responsibility to communicate findings and care plans clearly to patients, families, and the healthcare team.

Numerical references and definitions recap

• Key point total for example item: 5 points.
• Partial credit example: if 3/5 are correct, you earn 3 points.
• Signs/symptoms for DVT (correct):
  • Tenderness
  • Warmth
  • Swelling
  • Redness
• Incorrect DVT indicators (to avoid): dyspnea ( \text{dyspnea} \equiv \text{shortness of breath} ) and hemoptysis ( \text{hemoptysis} \equiv \text{bloody sputum} ), which are more associated with PE.
• Schematic relationships:
  • DVT in leg → risk of PE if clot migrates, which would present with dyspnea and hemoptysis.

Summary of takeaways

• Master the bow-tie format and nursing-process flow in test questions.
• Recognize and differentiate signs of DVT vs PE; apply partial-credit logic carefully.
• Know NGN item types: ordered response, drag-and-drop (fill-in, rationale), drop-downs, highlight items, matrix grids (matrix vs response matrix).
• Approach ATI assignments with emphasis on communication, both in content and in practical clinical context.

Final note

• Week 4 ATI assignments due under professional communications (two modules): factors affecting communication with individuals and groups; therapeutic communication. We will discuss more in class next week. Have a great evening.
• If you have any problems, please follow up with the instructor for clarification or help.