Which of the following findings is concerning to the nurse?

Choice A reason: This is not a concerning finding for the nurse. Absence of tears when the infant cries is normal and expected in the first few months of life. The tear ducts and glands are not fully developed yet, and the infant does not produce enough tears to moisten the eyes or overflow the eyelids. The nurse should monitor the infant's hydration and eye health, but should not be alarmed by the absence of tears.

Choice B reason: This is not a concerning finding for the nurse. Presence of vernix caseosa at delivery is normal and expected in newborns, especially those born before 40 weeks of gestation. Vernix caseosa is a white, cheesy substance that covers the skin of the fetus in the womb. It protects the skin from the amniotic fluid and helps with temperature regulation and infection prevention. The nurse should gently wipe off the excess vernix caseosa, but should not try to remove it completely.

Choice C reason: This is not a concerning finding for the nurse. Presence of anterior and posterior fontanels is normal and expected in infants. Fontanels are soft spots on the skull where the bones have not yet fused together. They allow the skull to be flexible and accommodate the growing brain. The nurse should palpate the fontanels gently and assess their size, shape, and tension, but should not be worried by their presence.

Choice D reason: This is the concerning finding for the nurse. Absence of the rooting reflex is abnormal and unexpected in infants. The rooting reflex is an involuntary movement or response that the infant makes when the cheek or mouth is touched. The infant turns the head and opens the mouth, seeking the source of stimulation. The rooting reflex is essential for breastfeeding and feeding in general. The nurse should assess the infant's neurological status and consult with the physician if the rooting reflex is absent.

Choice A reason: This is not the correct stage. Trust vs mistrust is the first psychosocial stage, which occurs from birth to 18 months. The main task of this stage is to develop a sense of trust in the caregivers and the environment.

Choice B reason: This is not the correct stage. Autonomy vs shame and doubt is the second psychosocial stage, which occurs from 18 months to 3 years. The main task of this stage is to develop a sense of independence and self-control.

Choice C reason: This is not the correct stage. Initiative vs guilt is the third psychosocial stage, which occurs from 3 to 6 years. The main task of this stage is to develop a sense of initiative and creativity.

Choice D reason: This is the best answer. Industry vs inferiority is the fourth psychosocial stage, which occurs from 6 to 12 years. The main task of this stage is to develop a sense of competence and achievement in social and school activities.