# A psychiatric inpatient offers the nurse a personal gift, requests a social-media connection after discharge, and asks for the nurse's private phone number for anxiety support. Which actions maintain therapeutic boundaries? Select all that apply.

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> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

A psychiatric inpatient offers the nurse a personal gift, requests a social-media connection after discharge, and asks for the nurse's private phone number for anxiety support. Which actions maintain therapeutic boundaries? Select all that apply.

1

Provide a private phone number so the former client can contact the nurse at any time after discharge

2

Accept the social-media request after discharge because the professional boundary ends when the client leaves the unit

3

Share brief information about the nurse only when it clearly benefits the client's care, without shifting the focus away from the client

4

Follow organizational policy for gifts and respectfully decline a personal gift that could create obligation, favoritism, or a shift toward a social relationship

5

Use the client's preferred name and professional language while avoiding pet names, romantic language, and terms of endearment

6

Arrange additional private meetings outside work hours to show that the relationship is more supportive than routine clinical care

## Explanation

Therapeutic boundaries keep care client-centered and protect both client and nurse. Self-disclosure is limited to information with a clear therapeutic purpose (Choice 3). Gift decisions follow organizational policy and consider value, context, culture, and potential obligation; a personal gift that could alter the professional relationship is respectfully declined (Choice 4). Professional forms of address avoid false intimacy or favoritism (Choice 5). Private phone access, off-hours meetings, and personal social-media connections create dual relationships and blurred roles; redirect the client to approved clinical, crisis, and community supports (Choices 1, 2, and 6). Professional and confidentiality obligations continue after discharge and in electronic communication.

## In-depth explanation

Clinical Judgment
The therapeutic relationship is client-centered, time-limited, and professional — not a friendship. The nurse evaluates every action with one filter: Does this serve the clinical goals of the client, or does it serve me? If it serves the nurse, decline.

Memory Tip
Boundary red flags = G-I-F-T: Gifts and personal phone · Information oversharing · Friend requests on social media · Time outside the schedule.

KR vs US
In Korean culture, declining a small gift can feel rude. NCLEX-RN expects the nurse to decline gracefully and to explain that acceptance is outside the professional role. Document the offer and the response in the chart.

## Clinical scenario

Clinical Practice Guide
ANA Code of Ethics for Nurses (2015), NCSBN guidelines on professional boundaries, and unit policies define crossings (small, recoverable lapses such as accepting an inexpensive token of appreciation) and violations (serious breaches such as financial, sexual, or social-media relationships). Crossings prompt reflection and supervision; violations require reporting and may end the nurse-client relationship.

Caution
Common NCLEX traps: accepting gifts to avoid offending the client, agreeing to social media contact after discharge, and giving the personal phone number to a vulnerable client. Remember: a kind action that crosses a boundary is still a violation — protect both client and nurse by saying no with respect.

## Key concepts

- **Professional Boundaries** — The lines between the helpful and the harmful in the nurse-client relationship. NCSBN places nurse behaviors on a continuum of under-involvement, therapeutic zone, and over-involvement; over-involvement includes excessive self-disclosure, gifts, social media contact, and dual relationships. NCLEX exam tip: any option that moves the nurse-client relationship toward friendship, romance, or financial entanglement is wrong.
- **Boundary Crossing vs Violation** — A boundary crossing is a brief, well-intentioned departure from professional norms (for example, accepting a small homemade card) that may be acceptable with reflection and supervision. A boundary violation is a serious breach that exploits the client (for example, sexual, financial, or social-media relationships). NCLEX exam tip: violations are reportable and can end the nurse license; crossings are warning signs to address through supervision.
- **Therapeutic Use of Self** — The deliberate, purposeful use of personality, insights, and skills to form a healing relationship while keeping the focus on the client. Includes selective self-disclosure that benefits the client, active listening, empathy, and professional presence. NCLEX exam tip: when an option lets the nurse share personal life freely or befriends the client, it crosses from therapeutic use of self into boundary violation.

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