During a tonic-clonic seizure, what is the nurse's priority action when the child begins to vomit?

The priority action when a child begins to vomit during a tonic-clonic seizure is to position the child side-lying. This position helps to prevent aspiration, which is particularly important since a seizure can compromise the child's airway and swallowing reflexes. Being in a side-lying position allows any vomitus to drain out of the mouth, reducing the risk of aspiration into the lungs, which could lead to severe complications such as aspiration pneumonia.

Maintaining a clear airway is crucial during seizure management, and positioning the child properly is a fundamental step in ensuring safety. While other actions, such as calling for additional medical staff or administering oxygen, may be important in certain contexts, the immediate need in this scenario involves protecting the child from choking or aspirating on vomit. Monitoring the heart rate can also be important in assessing the child’s overall condition, but it does not address the acute risk presented by the vomiting. Therefore, positioning the child side-lying is the most direct and effective approach to ensure their safety during this critical time.