Which action should the nurse take first when a patient starts a tonic-clonic seizure?

• A. Turn the client's head to the side.
• B. Check the client's motor strength.
• C. Loosen the clothing around the client's waist.
• D. Document the time the seizure began.

Answer: (A)

Protecting the airway is the first priority when a tonic-clonic seizure starts. Turning the patient onto the side (the recovery position) keeps the airway open and allows secretions or vomit to drain away from the airway, significantly reducing the risk of aspiration. Do not put anything in the mouth or try to restrain the patient’s movements. Once the airway is secured, you can time the seizure and monitor breathing and responsiveness, and after it ends you can assess motor function and loosen restrictive clothing if needed. Documenting when the seizure began is important, but it does not protect the patient in the moment like airway protection does.