Which of the following describes a common secretion change seen at the end of life?

• A. Anorexia and dehydration
• B. Death rattle
• C. Skin color changes only
• D. Increased urinary output

Answer: (B)

End-of-life secretions commonly change, and the death rattle is the typical example. As a person nears death, swallowing and coughing reflexes weaken, so mucus and saliva can pool in the upper airway. The air moving over these secretions creates a characteristic noisy, rattling sound, especially with each breath. This change is common in the final days and can be distressing for families, but it often reflects the body’s progression toward death and not necessarily pain or distress.

Other changes listed can occur near the end of life, but they’re not about secretions. Anorexia and dehydration describe reduced intake and fluid loss; skin color changes reflect circulation and perfusion changes; increased urinary output is not typical as kidney function and intake decline. The death rattle specifically describes the secretion change most commonly seen at the end of life.