A nurse is caring for a client who had an amniocentesis at 16 weeks gestation and reports cramping and vaginal bleeding 24 hours later.

Which of the following actions should the nurse take first?

To measure the fetal heart rate (FHR) in response to fetal movements.

This is because the FHR should increase by at least 15 beats per minute for at least 15 seconds when the fetus moves, which indicates a healthy and reactive fetus.

This is called an acceleration.

Choice B is wrong because the uterine contractions are not related to the fetal movements or the button pressing.

The uterine contractions are measured by a tocodynamometer or an intrauterine pressure catheter.

Choice C is wrong because the fetal oxygenation and neurological function are not directly measured by the button pressing.

The fetal oxygenation can be assessed by the FHR variability and decelerations, while the neurological function can be evaluated by other tests such as biophysical profile or fetal acoustic stimulation.

Choice D is wrong because the fetal well-being and hypoxia or distress are not indicated by the button pressing alone.

The fetal well-being and hypoxia or distress are determined by the FHR patterns, such as baseline, variability, accelerations and decelerations.

"It is a screening test for spinal defects in the fetus."

The MSAFP test is a blood test that measures the amount of alpha-fetoprotein (AFP) in the mother’s blood.

AFP is a protein produced by the baby during pregnancy.The test helps to assess the baby’s risk of certain birth defects, such as neural tube defects, which are abnormalities in the development of the brain and spine.

A. “It is a diagnostic test for spinal defects in the fetus.” This statement is wrong because the MSAFP test is not a diagnostic test.

It only indicates the probability of having a spinal defect, but it does not confirm or rule out the condition.A diagnostic test, such as an ultrasound or amniocentesis, is needed to make a definitive diagnosis.

C. “It is a diagnostic test for chromosomal abnormalities in the fetus.” This statement is wrong because the MSAFP test is not a diagnostic test for chromosomal abnormalities either.

It only indicates the probability of having a chromosomal abnormality, such as Down syndrome, but it does not confirm or rule out the condition.A diagnostic test, such as a chorionic villus sampling (CVS) or amniocentesis, is needed to make a definitive diagnosis.

D. “It is a screening test for chromosomal abnormalities in the fetus.” This statement is partially correct, but not the best answer.

The MSAFP test alone is not very accurate for screening chromosomal abnormalities.It is usually combined with other blood tests and an ultrasound to form a more reliable screening test called a quad screen or an integrated screen.

The normal range of MSAFP levels varies depending on the gestational age of the baby and the laboratory methods used.Generally, the MSAFP levels increase until about 15 weeks of pregnancy and then decrease until delivery.The average MSAFP level at 15 weeks of pregnancy is about 38 ng/mL.However, different laboratories may have different reference ranges, so it is important to consult your healthcare provider for your specific results and interpretation.