護理師進入病房發現病人出現強直陣攣癲癇發作。護理師應立即採取什麼行動？
A nurse enters a room and finds a client experiencing a tonic-clonic seizure. What should the nurse do immediately?
- APlace a tongue blade in the client's mouth將壓舌板置入病人口中
- BAttempt to insert an oral airway嘗試插入口咽通氣管
- CRestrain the client's limbs to prevent injury約束病人四肢以防止受傷
- DTurn the client to their side✓ 正解將病人轉為側臥
強直陣攣癲癇發作（Tonic-clonic seizure）時，病人的首要風險是呼吸道阻塞與受傷。護理師應立即將病人側臥（Recovery position），這有助於口腔內的分泌物、血液或嘔吐物順勢流出，防止誤吸（Aspiration），並避免舌頭後墜阻塞氣道。絕對禁止在發作時將任何物體放入病人嘴中，因為這可能導致牙齒斷裂、軟組織損傷或阻塞呼吸道。
During a tonic-clonic seizure, the patient's primary risks are airway obstruction and injury. The nurse should immediately turn the patient to a side-lying (recovery) position, which allows oral secretions, blood, or vomit to drain out, preventing aspiration and preventing the tongue from falling back to obstruct the airway. Inserting any object into the patient's mouth during a seizure is absolutely prohibited, as it may cause broken teeth, soft tissue injury, or airway obstruction.