A 10-year-old male is admitted to the acute care facility after having a tonic-clonic seizure. What priority nursing action would the nurse do immediately after the seizure?


•The first priority nursing action is to maintain a patent airway with the child lying on his side. The side-lying position reduces the risk of aspiration.

•Monitoring vital signs and neurologic status provides information about the extent of involvement and resolution of the seizure.

•Respiratory distress may indicate aspiration. This should be prevented by using the side-lying position.

Visit our website for other NCLEX topics now!