Select physical signs you may see in a patient who is actively dying.

Choice A rationale
Hypoglycemia, or low blood sugar, is not typically a manifestation of the fight-or-flight response. In fact, the opposite is true. During the fight-or-flight response, the body’s glucose levels often increase to provide extra energy for the perceived threat.
Choice B rationale
Dilated pupils are a common physical manifestation of the fight-or-flight response. This physiological change allows more light to enter the eyes, enhancing vision and awareness of the environment during a stressful event.
Choice C rationale
Bronchial airway constriction is not typically associated with the fight-or-flight response. In fact, the bronchial airways often dilate during this response to allow for increased oxygen flow, which is necessary for physical exertion.
Choice D rationale
Decreased blood pressure is not a typical response to stress. During the fight-or-flight response, blood pressure usually increases to enhance blood flow to the muscles and brain.

Choice A rationale
Initiating life-saving measures such as a rapid response call would not be appropriate in this context. The patient is in a hospice setting, which focuses on providing comfort and quality of life for patients who are nearing the end of life, rather than aggressive life-saving interventions.
Choice B rationale
Calling the provider because these signs and symptoms are abnormal would not be the correct response. In a hospice setting, these symptoms are expected and are indicative of the natural dying process.
Choice C rationale
The statement that rapid respirations that are unusually deep and regular are curative for the patient is incorrect. Cheyne-Stokes respirations, characterized by a pattern of increasing and then decreasing depth of breath followed by a period of apnea, are often seen in patients nearing the end of life. They are not curative but are a sign of the body’s decreasing metabolic demands and changing physiology as death approaches.
Choice D rationale
The nurse understanding that these are impending signs of death and are normal is the correct response. The symptoms described, including loss of appetite, swelling of the limbs, increased sleep, Cheyne-Stokes respirations, and hallucinations, are all common in the final stages of life.
Recognizing these signs can help the nurse provide appropriate care and support to the patient and their family during this time.