Certified Pediatric Emergency Nurse (CPEN) Practice Exam 2025 – All-in-One Guide to Master Your Certification!

An increased work of breathing is indeed a significant sign of respiratory distress in children. When a child is experiencing difficulties with breathing, their body compensates by using additional muscles, such as those in the neck and abdomen, to help enhance ventilation. This may manifest as noticeable retractions of the chest wall, nasal flaring, grunting, or even the use of accessory muscles.

Observing these signs can provide critical insight into the child's respiratory status and indicates that the child is struggling to breathe adequately. Therefore, increased work of breathing serves as a clear warning that immediate assessment and potential intervention are needed to address the underlying causes of the distress.

In contrast, decreased heart rate and reduced respiratory rate would suggest a potential decline in respiratory function or distress, as a child's heart rate typically increases in response to respiratory distress. Improved skin color might indicate adequate oxygenation and is usually a sign that the child is not in distress. Therefore, these latter signs do not reflect a state of respiratory distress, further underscoring why increased work of breathing is the most pertinent indicator in this scenario.