What should the nurse do first when a client starts having a tonic-clonic seizure?

When a client starts having a tonic-clonic seizure, the priority action is to turn the client's head to the side. This maneuver helps to keep the airway clear and prevents the potential for aspiration of secretions or vomit. Maintaining an open airway is crucial during a seizure because the client may not have control over their swallowing or breathing.

Positioning the client on their side not only helps to facilitate breathing but also reduces the risk of aspiration, which is particularly important during the postictal state (the recovery period following a seizure), when a person might be disoriented or less capable of protecting their own airway.

Other actions, while important in the overall management of a seizure, do not address the immediate safety concerns as effectively. For example, moving objects away can prevent injury, but it does not directly protect the airway. Checking the client's pulse is a secondary concern during the seizure itself, and placing an airway adjunct may not be necessary unless the seizure is prolonged or airway breathing has significantly compromised.