A nurse is reinforcing teaching about use of a metered-dose inhaler (MD) with a client who has a new diagnosis of asthma. Identify the sequence the client should follow. (Move the steps into the box on the right, placing them in the selected order of performance. Use all steps.)

A. Exhale slowly through pursed lips: Exhaling slowly through pursed lips after holding the breath ensures the medication remains in the airways, helps the client return to normal breathing and prevents discomfort after inhalation. B. Hold her breath for 10 seconds: Holding the breath allows the medication to deposit in the lungs rather than being exhaled immediately, maximizing absorption and therapeutic effect. C. Place her lips firmly around the mouthpiece: Creating a tight seal around the mouthpiece ensures that the medication is inhaled effectively and minimizes medication loss into the environment. D. Shake the canister 3 to 5 seconds vigorously: Shaking the inhaler mixes the medication evenly with the propellant, ensuring the correct dose is delivered. This step is essential before each use. E. Inhale slowly over 3 to 5 seconds while pushing down on the canister: Coordinating slow inhalation with activation of the inhaler allows the medication to reach deep into the airways for optimal effect.