A client with chronic obstructive pulmonary disease (COPD) smokes two packs of cigarettes per day and is admitted to the hospital for a respiratory infection. The client reports difficulty controlling respiratory distress at home when using the rescue inhaler. Which comment from the client indicates to the nurse that the client is not using the inhaler properly?

A. "I always shake the inhaler several times before I start": This comment suggests that the client may be swallowing the medication instead of properly inhaling it. Inhalers are designed to deliver medication directly to the lungs, and swallowing the medication reduces its effectiveness and may cause systemic side effects, such as nausea. Proper inhaler technique requires the client to inhale deeply while pressing the inhaler and to avoid swallowing the medication. B. "After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, but it goes away": While swallowing the medication is not the intended action for inhalers, feeling nausea may indicate improper use. However, this is not the most critical misuse. It suggests the client may not be inhaling the medication correctly, but this answer does not highlight the most important mistake, which is the delay in using the inhaler. C. "I never use the inhaler unless I am feeling really short of breath": While this comment reflects underuse of the inhaler, it does not indicate incorrect technique. However, it does suggest a need for education on the importance of preventive or maintenance use of inhalers, depending on the prescribed regimen. D. "I have a hard time inhaling and holding my breath after I squeeze the inhaler, but I do my best": Difficulty with proper inhalation and breath-holding is common, but this can be addressed by using inhalation techniques or devices like a spacer. This response does not indicate a fundamental misuse of the inhaler like waiting too long to use it.