A nurse is teaching a child who has asthma about using a metered-dose inhaler with a mouthpiece. Identify the sequence of steps the nurse should instruct the child to take. (Move the steps below into the box on the right, placing them in the order of performance. Use all the steps.)

Using a metered-dose inhaler (MDI) correctly is all about timing and technique to ensure the medication actually reaches the lungs instead of just hitting the back of the throat. Here is the correct sequence of steps the nurse should teach the child: Choice A: Depress the canister while inhaling slowly. The child should start a slow, deep breath and press the canister at the beginning of that inhalation to draw the mist deep into the airways. Choice C: Hold breath for 10 seconds. Once the inhalation is complete, holding the breath allows the tiny droplets of medicine to settle into the lower lungs rather than being immediately exhaled. Choice B: Remove the inhaler from the mouth. After the breath-hold, the device is removed before exhaling to ensure no moisture from the breath gets into the mouthpiece. Choice D: Exhale slowly through the nose. A controlled exhale completes the process and prepares the child for a second puff if one was prescribed. Pro-Tips for Pediatric Use Shake it up: Always remind the child to shake the inhaler for 3-5 seconds before use. The "Wait" Rule: If a second puff of the same medication is needed, it’s best to wait about 30–60 seconds between inhalations. Spacer Benefits: For many children, using a spacer is highly recommended because it eliminates the need for perfect "press-and-breathe" coordination.