A 4-month-old has been admitted to the pediatric medical unit with respiratory syncytial virus (RSV). The infant demonstrates poor feeding and begins coughing frequently. Which additional finding should alert the nurse that the child is experiencing respiratory distress?

Rationale: A. Flaring of the nares: Flaring of the nares occurs when the infant is working harder to breathe and indicates increased respiratory effort. In the context of RSV with poor feeding and frequent coughing, this is a key sign of respiratory distress that requires prompt attention. B. Diaphragmatic respirations: Diaphragmatic (abdominal) breathing is normal in infants and reflects typical respiratory mechanics. It does not indicate respiratory distress unless accompanied by other abnormal signs like retractions or nasal flaring. C. Resting respiratory rate of 35 breaths/minute: A respiratory rate of 35 is within the normal range for a 4-month-old (30–60 breaths/minute). Alone, it does not signify distress, though trends or additional signs should be monitored. D. Bilateral bronchial breath sounds: Bilateral bronchial breath sounds can be normal over the central airways. This finding does not indicate respiratory distress and may reflect normal auscultatory findings in infants.