Maternity Nursing Q 178
When a pregnant woman goes into a convulsive seizure, the MOST immediate action of the nurse to ensure the safety of the patient is:
A. Apply restraint so that the patient will not fall out of bed.
B. Put a mouth gag so that the patient will not bite her tongue and the tongue will not fall back.
C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration.
D. Check if the woman is also having precipitate labor.
Correct Answer: C. Position the mother on her side to allow the secretions to drain from her mouth and prevent aspiration.
Positioning the mother on her side will allow the secretions that may accumulate in her mouth to drain by gravity thus preventing aspiration pneumonia.
Option A: Placing a patient who is in seizure in restraints would further injure him or her. Place the patient on a flat, firm surface during seizure.
Option B: Putting a mouth gag is not safe since during the convulsive seizure the jaw will immediately lock.
Option D: The mother may go into labor also during the seizure, but the immediate concern of the nurse is the safety of the baby. After the seizure, check the perineum for signs of precipitate labor.