While the nurse is performing morning care, a client begins to have a

While the nurse is performing morning care, a client begins to have a seizure. What should the nurse do to help this client?

1. Insert a tongue blade into the client’s mouth.
2. Loosen any clothing around the neck and chest.
3. Restrain the client.
4. Turn the client to the supine position if possible.

ANSWER

Correct Answer: 2
Rationale 1: Research has found that more injury can occur to the client if the caregiver tries to place anything in the mouth during the seizure.
Rationale 2: Loosening any clothing around the neck and chest prevents constriction that might occur during the seizure that could compromise the airway.
Rationale 3: A client should never be restrained during a seizure. The nurse should stay with the client and call for assistance, if needed.
Rationale 4: If possible, the client should be turned to the lateral position, not supine, to allow for any secretions to drain out of the mouth.