A nurse enters the room, and the client, who is sitting in a chair, begins to have a seizure. The nurse should:
A. Run for help
B. Guide the client to the floor
C. Put the client back into the bed
D. Insert a padded tongue blade into the client's mouth
B
B. When seizure begins, position client safely. If standing or sitting, guide client to floor and protect head by cradling in nurse's lap or placing pillow under head. Clear surrounding area of furniture. If client is in bed, raise side rails, pad, and put bed in low position.
A. Stay with client, observing sequence and timing of seizure activity. Continued observation ensures adequate ventilation during and following seizure and will assist in documentation, diagnosis, and treatment of seizure disorder.
C. If the client is in bed, raise side rails, pad, and put bed in low position.
D. Do not force any objects into client's mouth such as fingers, medicine, or tongue depressor, or airway when teeth are clenched. Prevents injury to mouth and prevents possible aspiration.
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