greater-than-expected head circumference and bulging fontanels
Number 4 is correct.
Rationale: Greater-than-expected head circumference and bulging fontanels are a finding of shaken baby syndrome due to subdural brain hemorrhage. An infant at 2 months does not yet track with the eyes. Crying is not a typical sign of shaken baby syndrome. External signs of abuse are usually absent; retinal hemorrhage is revealed on ophthalmoscopic examination. The nurse is legally obligated to report all cases of suspected child abuse or neglect.
