# A 63-year-old female is being discharged after a 14-day hospitalization following complex coronary artery bypass graft. On discharge day, she hands the primary nurse an envelope containing $500 cash, saying "You saved my life — please take this." Which response by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: MOC

## Question

A 63-year-old female is being discharged after a 14-day hospitalization following complex coronary artery bypass graft. On discharge day, she hands the primary nurse an envelope containing $500 cash, saying "You saved my life — please take this." Which response by the nurse is most appropriate?

## Option

1. Recommend that the client redirect the monetary gift to the hospital's nursing staff education fund as an alternative.
2. Thank the client sincerely and explain that accepting monetary gifts is not permitted under professional standards. **✔ Correct answer**
3. Direct the client to the charge nurse, stating that the charge nurse will determine if the gift can be accepted.
4. Accept the envelope of cash as it is a personal gesture offered after discharge and may not breach any explicit facility policy.

**Correct answer: 2**

## Explanation

Professional boundaries protect the therapeutic nurse-client relationship and the nurse's professional integrity. Accepting monetary gifts, regardless of amount or intent, violates professional boundaries and may create dependency or the appearance of favoritism. The nurse must respond with warmth while firmly declining — explaining professional standards, not making the client feel guilty. Referring to the charge nurse avoids the boundary conversation the nurse is responsible for having. Suggesting a donation sidesteps the direct professional boundary explanation.

## In-depth explanation

Clinical Judgment
The therapeutic relationship is built on professional trust, not personal exchange. A $500 gift after 14 days creates a boundary problem regardless of gratitude. The nurse must directly, kindly address the gift — not delegate, redirect, or accept secretly.

Memory Tip
Professional Boundary Rule: Thank → Decline → Explain standard → Continue care. Never delegate this conversation.

KR vs US
In Korean culture, gift-giving to healthcare providers is traditional. NCLEX applies US professional boundary standards: monetary gifts are always declined regardless of cultural context.

## Clinical scenario

Clinical Practice Guide
ANA Code of Ethics (Provision 2): the nurse commits to the patient and recognizes the vulnerability created by the nurse-patient relationship. NCSBN Boundary Violations: accepting gifts, especially monetary, exploits the power differential and compromises professional integrity.

Caution
NCLEX "professional boundaries" questions often have a high-stakes emotional context. The answer is always warm refusal with a professional explanation — never acceptance in any form, never delegation as avoidance.

## Key concepts

- **Professional Boundaries** — Standards defining the limits of the therapeutic nurse-patient relationship. Boundary violations: accepting gifts, sharing personal information, dual relationships. NCLEX: boundaries exist to protect the client, not the nurse's convenience.
- **Therapeutic Relationship** — A goal-directed nurse-patient connection based on professional interaction. Characterized by empathy, unconditional positive regard, genuineness, and professionalism. Distinguished from personal friendship or commercial transaction.
- **Boundary Violations** — Actions that cross the limits of the therapeutic relationship. Examples: accepting gifts, sharing private contact information, excessive self-disclosure. NCLEX: even minor boundary violations can escalate to exploitative relationships.

## Related questions

- [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en)
- [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. W…](https://mymerci.kr/pages/nclex_q.php?qn_id=360523&lang=en)
- [A client with newly diagnosed metastatic colon cancer is admitted to a medical-surgical un…](https://mymerci.kr/pages/nclex_q.php?qn_id=362185&lang=en)
- [A 65-year-old female client received intravenous morphine 30 minutes ago for postoperative…](https://mymerci.kr/pages/nclex_q.php?qn_id=362206&lang=en)
- [A 78-year-old male client with end-stage pancreatic cancer is enrolled in inpatient hospic…](https://mymerci.kr/pages/nclex_q.php?qn_id=362322&lang=en)
- [A nurse on a medical-surgical unit is starting a 0700 round and reviews these four assigne…](https://mymerci.kr/pages/nclex_q.php?qn_id=362403&lang=en)
- [An RN is assigning care on a medical-surgical unit to an LPN/VN and a trained unlicensed a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362464&lang=en)
- [The charge nurse on a medical-surgical unit is assigning tasks for a licensed practical nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=393555&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=372685&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._