A nurse is reinforcing teaching with a client who has a new prescription for methotrexate for the treatment of rheumatoid arthritis. The nurse should instruct the client to notify the provider of which of the following manifestations?

A. Urinary frequency is not a common adverse effect of methotrexate. B. Increased hunger is unrelated to methotrexate therapy. C. Some continued joint pain is expected for the first few weeks as the medication takes effect. D. Malaise, fatigue, or signs of infection can indicate bone marrow suppression, a serious adverse effect of methotrexate. Clients should report these symptoms promptly to the provider.