# Stage 4 — Generate solutions. Select all nursing actions that belong in Mr. K's individualized comfort-care plan at this time.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372807&lang=en  
> language: en  
> subject: Personal Hygiene  
> category: BCC

## Question

Stage 4 — Generate solutions. Select all nursing actions that belong in Mr. K's individualized comfort-care plan at this time.

1

Perform repeated deep oropharyngeal suctioning on a fixed schedule until all airway sound disappears.

2

Use the prescribed subcutaneous morphine dose for observed dyspnea because oral swallowing is unsafe, then reassess comfort and adverse effects.

3

Obtain cultures and start IV antibiotics solely because of the low oxygen saturation, without evaluating symptom benefit or the documented goals.

4

Provide frequent gentle mouth and lip care and avoid forcing oral fluids or medications when the client coughs or pockets fluid.

5

Raise the head of the bed, use supported side-lying, continue oxygen if it improves comfort, and consider the prescribed glycopyrrolate trial for distressing secretions.

6

Explain the breathing changes and comfort plan while care is delivered, invite family presence and questions, and offer chaplain and social-work support.

## Explanation

Why options 2, 4, 5, and 6 fit
Option 2 uses the prescribed alternate route for dyspnea when swallowing is unsafe and requires reassessment. Option 4 protects against aspiration while relieving dry mouth. Option 5 uses low-burden positioning, comfort-beneficial oxygen, and an individualized antisecretory trial rather than promising elimination of all sound. Option 6 makes family communication concurrent clinical care.

Why options 1 and 3 fail
Repeated deep suctioning can add trauma and distress and is not warranted simply to remove death-rattle sound. Tests and antibiotics are not automatically prohibited, but starting them solely for an abnormal number without weighing reversible symptom benefit, burdens, and the documented goals is not individualized care.

## In-depth explanation

Symptom relief
Use behavioral evidence of dyspnea or pain, a route the client can tolerate, and prompt reassessment. Opioids may relieve end-of-life breathlessness. Oxygen is continued here because he has chronic lung disease, symptomatic hypoxemia, and an existing oxygen plan, but comfort rather than saturation normalization is the goal.

Secretions
Explain that noisy pooled secretions often distress family more than the dying person. Repositioning and mouth care come first; a prescribed antimuscarinic trial may be considered and monitored for benefit and adverse effects.

Communication
Do not postpone explanation until after treatment. Tell the family what the nurse sees, what is being done, and how response will be judged.

## Clinical scenario

Scenario (Stage 4 — Generate solutions)
The nurse now converts the analysis into a goal-concordant care bundle.

Clinical judgment target
Select route-safe symptom relief and concurrent family support without treating DNR as abandonment of care.

## Key concepts

- **Opioid for end-of-life dyspnea** — A prescribed opioid may reduce the sensation and observable burden of breathlessness; dose and route are individualized and response and adverse effects are reassessed.
- **Antimuscarinic trial** — A prescribed medication such as glycopyrrolate may be tried for distressing noisy secretions, with monitoring because benefit varies and dry mouth, retention, or other adverse effects can occur.
- **Comfort-beneficial oxygen** — Oxygen is not started routinely for every dying person with breathlessness; it may be continued or offered when symptomatic hypoxemia is known or suspected and observed comfort improves.

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