A nurse is caring for a client in the emergency department. Exhibits A nurse is teaching a client about their new prescription. Which of the following statements should the nurse include in the teaching? Select all that apply.

A. Double-flush the toilet with the lid closed – Methotrexate is a hazardous medication that is excreted in body fluids. The client should be instructed to double-flush the toilet with the lid closed for 48 hours to prevent exposure to others. B. Avoid sexual intercourse until the β-hCG level is undetectable – This reduces the risk of rupture or bleeding and prevents confusion with another pregnancy. Abstinence is recommended until the ectopic pregnancy is fully resolved. C. Take aspirin as needed for pain – Aspirin is contraindicated as it increases the risk of bleeding and can interact adversely with methotrexate, enhancing toxicity. D. Avoid exposure to the sun – Methotrexate can cause photosensitivity, and the client should use sunscreen and protective clothing when outdoors. E. Expect a transient fever and chills – Fever and chills are not expected side effects of methotrexate. These symptoms may indicate infection or rupture and should be reported immediately.