A nurse is providing teaching to a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following instructions should the nurse include? (Select all that apply.)

A. Take NSAIDs to help minimize the adverse effects of the medication: Taking NSAIDs with methotrexate can increase the risk of gastrointestinal toxicity and kidney damage. NSAIDs should generally be avoided or used with caution in clients taking methotrexate. B. Do not drink alcoholic beverages while taking this medication: Alcohol can increase the risk of liver damage when taken with methotrexate. It is important for the client to avoid alcohol to minimize this risk. C. Expect to feel the medication's effects immediately: Methotrexate does not provide immediate relief, and its full therapeutic effects may take several weeks to become apparent. The client should be informed of this to manage expectations. D. Report unexplained bruising to the provider: Unexplained bruising can indicate potential bone marrow suppression, a serious adverse effect of methotrexate. The client should report this symptom to their healthcare provider immediately. E. Avoid people who have infections: Methotrexate suppresses the immune system, making the client more susceptible to infections. Therefore, the client should avoid close contact with people who have infections to reduce the risk of illness.