Respiratory failure is imminent in infants who demonstrate which of the following?

a. Substernal retractions
b. Tachypnea
c. Grunting
d. Nasal flaring

ANS: C
Infants attempt to maintain a back pressure in the lungs to preserve the functional residual capac-ity by narrowing the glottis and maintaining respiratory muscle activity (active exhalation). This results in vocalization during exhalation, or "grunting," which is often mistaken for crying. Grunting, which usually can be heard without auscultation, is a useful clinical sign of impending respiratory failure.

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