Question

A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the best initial action by the nurse?

1) Trying to open the jaw
2) Placing the child on the floor
3) Calling out for assistance from staff
4) Placing a pillow under the child's head

Answer 1

The best initial action by a nurse when a child is having a seizure is to place the child on the floor to prevent falls and injury, call for assistance from staff, and ensure the child's safety.

Step-by-step explanation:

The best initial action by the nurse when a child is having a tonic-clonic seizure with a clenched jaw would not be trying to open the jaw due to the risk of injury. Instead, the nurse should prioritize the safety of the child by placing the child on the floor to prevent a fall and potential injury. After making sure the environment is safe, the nurse should then call out for assistance from staff while maintaining the child's safety. Placing a pillow under the child's head for protection could be considered if readily available, but it is not the most immediate action required. It is also critical not to attempt the Heimlich maneuver or any other intervention aimed at choking, as this is a seizure and not an airway obstruction.