Pediatric ATI Practice Exam

After a tonic-clonic seizure, which action should the school nurse take first?

1. Check the child for a head injury.

2. Observe for oral bleeding.

3. Check the child's respiratory rate.

4. Observe for extremity weakness.

The correct answer is: Check the child's respiratory rate.

After a tonic-clonic seizure, the first priority is to check the child's respiratory rate. Seizures can cause various complications, including respiratory distress due to airway obstruction, tongue biting, or reduced consciousness. Monitoring the respiratory rate ensures that the child is breathing adequately and can help identify any need for immediate interventions such as providing oxygen or repositioning the child to maintain an open airway. Checking for a head injury, observing for oral bleeding, and looking for extremity weakness are all important aspects of postictal care as well. However, they are secondary to ensuring that the child is breathing effectively. Focus on respiratory assessment aligns with the critical need to stabilize the child's physiological state following a seizure, which can significantly impact their recovery and safety.