Pediatric ATI Practice Exam

During a tonic-clonic seizure in a school-age child, what should the nurse do first?

1. Clear the immediate area around the child of hazardous objects

2. Loosen the child's restrictive clothing

3. Assist the child to a side-lying position on the floor

4. Apply an oxygen mask to the child

The correct answer is: Assist the child to a side-lying position on the floor

During a tonic-clonic seizure, the immediate priority is to ensure the safety of the child while the seizure is occurring. Assisting the child to a side-lying position is crucial because this position helps maintain an open airway and reduces the risk of aspiration. By placing the child on their side, any saliva or fluids are more likely to drain out rather than being inhaled, which can lead to complications such as choking or respiratory distress. While clearing the area of hazards is also important for safety, and loosening restrictive clothing helps with comfort and airway management, the primary concern during a seizure is to protect the airway. Applying oxygen is not typically initiated until after the seizure has stopped and if the child is in respiratory distress, taking priority action during the active seizure itself is essential. Thus, positioning the child safely is the most immediate and critical response.