A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse provide?

A. Expect to have a fever for the first days of therapy: Fever is not a typical side effect of methotrexate therapy. While methotrexate can cause various side effects, including gastrointestinal issues and liver toxicity, fever is not commonly expected. B. Drink 2 to 3 L of water per day while on the medication: Methotrexate can affect kidney function, and staying hydrated helps reduce the risk of kidney toxicity. Drinking plenty of fluids is important when taking methotrexate. C. Take the medication in the morning to prevent insomnia: Insomnia is not a common side effect of methotrexate, and there is no specific instruction to take it in the morning. The medication is taken once a week, not daily, and timing is not related to sleep disturbances. D. Administer the medication with an NSAID to enhance effectiveness: Methotrexate should not be taken with NSAIDs due to the increased risk of toxicity, particularly in the kidneys and gastrointestinal system.