A patient with rheumatoid arthritis is prescribed hydroxychloroquine. Which of the following statements by the patient indicates a need for further education regarding the medication?

Rationale: A. Hydroxychloroquine is not a strong immunosuppressant, so most live vaccines are generally considered safe. Patients should still consult their healthcare provider before receiving vaccines, but this statement does not indicate a misunderstanding requiring further education. B. Hydroxychloroquine has the potential to cause retinal toxicity, which can lead to permanent vision loss if not detected early. Baseline ophthalmologic exams during the first year of therapy, followed by regular follow-ups (usually annually), are recommended to monitor for early retinal changes. Patient understanding of this precaution shows correct knowledge. C. Although hydroxychloroquine does not have a direct interaction with alcohol, excessive alcohol intake increases the risk of liver toxicity and may exacerbate other side effects such as gastrointestinal discomfort. Patients should be educated to limit alcohol consumption and discuss safe limits with their healthcare provider. This is particularly important for patients taking long-term therapy, as liver monitoring may be required. D. Visual changes, such as blurred vision, difficulty reading, or changes in color perception, may indicate early retinal toxicity. Prompt reporting allows early intervention and prevention of permanent damage. Patient understanding of this is accurate and demonstrates appropriate safety awareness.