A nurse is teaching a client prescribed methotrexate about potential dietary restrictions. Which statement indicates the correct understanding of the teaching?

Rationale: A. NSAIDs can increase the risk of methotrexate toxicity by reducing renal clearance, which may lead to dangerous accumulation and increased risk of liver or bone marrow toxicity. Clients are advised to consult their provider before taking any over-the-counter medications. B. Methotrexate inhibits folate metabolism, which is why folic acid supplementation is often prescribed. However, dietary folate alone is insufficient to prevent toxicity, and clients should follow prescribed folic acid supplementation rather than relying solely on diet. C. Some vitamins and supplements, especially those containing high doses of folic acid, iron, or other interacting compounds, may interfere with methotrexate’s effectiveness or toxicity profile. Clients should confirm all supplements with their provider. D. Methotrexate can cause hepatotoxicity, and alcohol consumption further increases this risk. Avoiding alcohol is a key teaching point to minimize liver damage while on therapy.