Certified Pediatric Emergency Nurse (CPEN) Practice Exam 2025 - Free CPEN Practice Questions and Study Guide

The observation of retractions is a key indicator that a child is utilizing accessory muscles of breathing. In normal breathing, the diaphragm and intercostal muscles primarily facilitate respiration. However, when a child experiences respiratory distress, they may recruit additional muscles to assist with breathing. This recruitment is often manifested visually as retractions, where the skin sinks in around the ribs or the sternum during inhalation.

Retractions can be seen when there is increased work of breathing, a common scenario in conditions such as asthma, pneumonia, or severe respiratory infections. This physical sign suggests that the child is struggling to breathe effectively, prompting the use of these additional muscle groups in an effort to expand the chest cavity more than usual.

Other options, while they may relate to respiratory challenges or distress, do not specifically indicate the use of accessory muscles. Bradycardia is generally more indicative of potential cardiovascular complications, hyperactivity may reflect anxiety or other issues not directly tied to respiratory muscle use, and fatigue can imply a general state of exhaustion but does not directly signify the mechanics of breathing.