The practical nurse (PN) is observing a two-year-old child at play.
Which should the PN consider normal behavior for a toddler?

Choice A rationale

A resting respiratory rate of 35 breaths/minute for a 4-month-old infant is within the normal range (typically 30-60 breaths/minute). Therefore, this finding alone does not indicate acute respiratory distress.

Choice B rationale

Bilateral bronchial breath sounds are normal findings when auscultated over the trachea. However, their presence over the peripheral lung fields can indicate consolidation, such as in pneumonia. While abnormal in the periphery, it is not an isolated sign of acute respiratory distress.

Choice C rationale

Diaphragmatic respirations, also known as abdominal breathing, are the predominant and normal breathing pattern in infants and young children due to the preferential use of the diaphragm for respiration. This is not a sign of respiratory distress.

Choice D rationale

Flaring of the nares is a significant clinical sign of increased work of breathing and respiratory distress in infants. It indicates that the infant is attempting to decrease airway resistance and maximize oxygen intake by dilating the nasal passages. This is a compensatory mechanism indicating respiratory compromise.

Choice A rationale

The last day of the last normal menstrual period would not accurately establish the estimated date of birth because calculations for gestational age commence from the onset of the cycle. Conception typically occurs around two weeks after the first day, so using the last day would lead to an underestimation of gestational age.

Choice B rationale

The average duration of menstrual periods, while providing insight into cycle regularity, does not offer the precise temporal marker needed for gestational age calculation. Nägele's rule specifically requires the first day of the last menstrual period, not the length of bleeding, to accurately estimate the delivery date.

Choice C rationale

The average frequency of menstrual periods, though indicating cycle regularity or irregularity, is not the specific data point required for estimating the delivery date. Nägele's rule relies on a fixed reference point, which is the beginning of the last menstrual cycle, not the intervals between cycles.

Choice D rationale

The first day of the last normal menstrual period (LMP) is crucial for accurately assigning an estimated date of birth (EDB) using Nägele's rule. This calculation adds 7 days to the LMP and subtracts 3 months, providing a standardized method for determining gestational age and anticipated delivery.