The nurse is caring for a client who takes methotrexate for rheumatoid arthritis and receives a prescription for adalimumab. Which instructions should the nurse provide the client?

A. Obtain routine vaccinations as scheduled: Live vaccines should be avoided while taking adalimumab because it suppresses immune function, increasing the risk of vaccine-related infection. Inactivated vaccines may be given but require provider guidance regarding timing. B. Have a chest x-ray prior to your first dose: A chest x-ray is not routinely required before starting adalimumab unless tuberculosis is suspected. Screening for latent TB is essential, but this is typically done with a TB skin test or interferon-gamma release assay rather than a chest x-ray alone. C. Undergo annual eye examinations: Eye exams are important for certain medications like hydroxychloroquine but are not a standard requirement for adalimumab use. Adalimumab’s primary risks relate to infection and immune suppression rather than ocular toxicity. D. Avoid crowds and people who are sick: Adalimumab is a TNF-alpha inhibitor that suppresses the immune system, increasing susceptibility to infections. Avoiding exposure to people with contagious illnesses helps reduce the risk of serious infections during therapy.