A nurse is providing teaching about the use of metered-dose inhalers to a client who has asthma. Which of the following instructions should the nurse include?

A. "Hold your breath for 10 seconds after each puff.": This allows the medication to deposit deeply into the airways, enhancing absorption and therapeutic effect. It is a key step in proper MDI technique. B. "Inhale rapidly for 1 to 2 seconds after depressing the canister.": Inhalation should be slow and deep over 3 to 5 seconds to allow proper delivery of the medication into the lungs. C. “Hold the mouthpiece 4 inches away from your open mouth.”: The preferred technique is to place the mouthpiece directly in the mouth with lips sealed around it unless a spacer is used. D. "Tilt your head forward while inhaling.": The correct method is to tilt the head slightly back to open the airway and facilitate deeper inhalation of the medication.