# A patient is in the active dying phase from end-stage heart failure. Family members are at the bedside. Which nursing interventions support a comfortable, dignified death? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=en  
> language: en  
> subject: Basic Care and Comfort  
> category: BCC

## Question

A patient is in the active dying phase from end-stage heart failure. Family members are at the bedside. Which nursing interventions support a comfortable, dignified death? Select all that apply.

1

Provide frequent oral care with mouth swabs and moist lips/oral mucosa for comfort, even though the patient is unresponsive.

2

Reposition the patient laterally and slightly elevate the head of bed to allow secretions to drain by gravity, rather than aggressive deep suctioning.

3

Use deep oropharyngeal suctioning to clear secretions, as this reduces the distressing 'death rattle' sounds for the family.

4

Encourage family members to talk to the patient and offer touch — hearing is thought to remain intact even at end of life.

5

Administer a scheduled or PRN antimuscarinic (for example, glycopyrrolate or atropine) to reduce production of upper airway secretions.

## Explanation

At end of life, comfort takes priority. The "death rattle" is upper-airway secretions pooling because the patient cannot swallow — it is much more distressing to family than to the patient and is best addressed with positioning + antisecretory agents (glycopyrrolate, atropine, scopolamine). Frequent oral care and family presence/touch support dignity. Aggressive deep suctioning (3) is uncomfortable, traumatic, and rarely improves the rattle — it should be avoided unless there is true upper airway obstruction.

## In-depth explanation

The single most-tested end-of-life teaching point is "do not deep suction for the death rattle." Family members benefit from explanation that the breathing pattern and noise do not signify suffering and that the patient is unaware of it. Comfort medications (morphine for dyspnea, glycopyrrolate for secretions) hasten neither dying nor distress.

## Clinical scenario

**Patient in active dying phase from end-stage heart failure** on hospice. The patient is unresponsive with mottling, irregular respirations, and audible upper-airway secretions ("death rattle"). Family is at the bedside.

## Key concepts

- **Active dying phase** — Final hours-to-days marked by mottling, Cheyne-Stokes or irregular respirations, decreased urine output, and unresponsiveness.
- **Death rattle** — Audible upper-airway secretions in the dying patient unable to swallow; managed with positioning and antimuscarinics.
- **Glycopyrrolate / atropine** — Antimuscarinic agents that reduce salivary and bronchial secretions in active dying; first-line for terminal secretions.

## Related questions

- [A patient with cirrhosis and grade 2 hepatic encephalopathy has been started on lactulose.…](https://mymerci.kr/pages/nclex_q.php?qn_id=372852&lang=en)
- [A 78-year-old with end-stage pancreatic cancer is admitted to the medical ward. After revi…](https://mymerci.kr/pages/nclex_q.php?qn_id=372916&lang=en)
- [A nurse is caring for an immobile, malnourished older adult at high risk for pressure inju…](https://mymerci.kr/pages/nclex_q.php?qn_id=373515&lang=en)
- [A patient is post-op day 0 from a transurethral resection of the prostate (TURP) with a th…](https://mymerci.kr/pages/nclex_q.php?qn_id=374201&lang=en)
- [A 6-year-old is admitted with newly diagnosed nephrotic syndrome: proteinuria 4+, serum al…](https://mymerci.kr/pages/nclex_q.php?qn_id=374922&lang=en)
- [A nurse is caring for a postpartum patient who has saturated 2 perineal pads in 30 minutes…](https://mymerci.kr/pages/nclex_q.php?qn_id=374930&lang=en)
- [A nurse is implementing trauma-informed care for a client with a history of intimate partn…](https://mymerci.kr/pages/nclex_q.php?qn_id=374978&lang=en)
- [A nurse is supporting a family meeting where the medical team is discussing transition to …](https://mymerci.kr/pages/nclex_q.php?qn_id=374987&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=373259&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=373259&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._