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?

The correct answer is choice A. Notify the health care provider immediately.

This is because cramping and vaginal bleeding 24 hours after amniocentesis are signs of possible complications, such as injury to the baby or mother, leaking of amniotic fluid, infection, Rh sensitization, preterm labor, or miscarriage.

These complications are rare, but they can be serious and require immediate medical attention.

Choice B is wrong because administering pain medication to the patient does not address the underlying cause of the cramping and bleeding, and may delay seeking help.

Choice C is wrong because encouraging the patient to rest and elevate her legs may not prevent further complications, and may also delay seeking help.

Choice D is wrong because offering emotional support and reassurance to the patient is not enough to ensure the safety of the baby and the mother, and may give a false sense of security.

Normal ranges for amniocentesis are:

No chromosomal defects detected in the fetus and no abnormal proteins present in amniotic fluid

No signs of infection or other illness in the baby

Fetal lungs mature enough for birth if delivery is planned sooner than 39 weeks

This is because a nuchal translucency ultrasound measures the amount of fluid behind the baby’s neck in the first trimester of pregnancy, which can indicate the risk of having a chromosomal condition like Down syndrome.

Some possible explanations for the other choices are:

Choice A is wrong because fetal growth and development are not directly related to the nuchal translucency measurement.

Fetal growth and development are assessed by other parameters such as crown-rump length, biparietal diameter, abdominal circumference, etc.

Choice B is wrong because blood flow in the umbilical cord is not measured by the nuchal translucency ultrasound.

Blood flow in the umbilical cord is assessed by Doppler ultrasound, which evaluates the resistance and velocity of blood flow in the umbilical artery and vein.

Choice D is wrong because structural abnormalities in the baby’s organs are not detected by the nuchal translucency ultrasound.

Structural abnormalities in the baby’s organs are diagnosed by a detailed anatomy scan, which is usually performed in the second trimester of pregnancy.

The normal range for nuchal translucency is between 1 mm and 3 mm.

A measurement above 3 mm is considered increased and may indicate a higher risk of chromosomal or genetic conditions.

However, a nuchal translucency ultrasound is a screening test and not a diagnostic test, so it does not confirm or rule out any condition.

It only provides a probability based on statistical calculations.

Therefore, further testing may be recommended if the nuchal translucency measurement is increased or if other risk factors are present.