The physician has ordered intravenous phenytoin (Dilantin) for seizures. The client is also receiving 5% dextrose in water (D5W) intravenously (IV). What will the nurse plan to do before administering this medication? (Select all that apply.)

Question

1. Flush the IV line with saline
2. Monitor the client for hypertension
3. Use an IV line with a filter
4. Use a large vein for the infusion
5. Monitor the client for Stevens-Johnson Syndrome

Answer 1

1. Flush the IV line with saline
3. Use an IV line with a filter
4. Use a large vein for the infusion

Rationale:
Intravenous lines of D5W must be flushed with saline, as traces of dextrose can cause microscopic precipitate formations that become emboli, if infused. An intravenous filter will trap any precipitate that occurs. Phenytoin (Dilantin) is a soft-tissue irritant that will cause local tissue damage if extravasation occurs, so a large vein must be used for infusion. Clients receiving phenytoin (Dilantin) are at risk for hypotension, not hypertension. Stevens-Johnson Syndrome is a side effect of phenytoin (Dilantin), but it takes days to occur.