A nurse is teaching a client who has a new prescription for a metered-dose inhaler. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. Spacers are devices that can be attached to MDIs to help improve medication delivery to the lungs. They reduce the need for precise coordination between inhalation and actuation, making it easier for the medication to reach the lungs. B Inhaling slowly allows the medication to be dispersed and distributed more effectively throughout the lungs. Rapid inhalation may cause the medication to impact the back of the throat rather than reaching the lungs. Instructing the client to inhale slowly helps maximize the amount of medication that reaches the airways. C. Holding the mouthpiece between the lips and forming a good seal with the lips helps ensure that the medication is delivered directly into the airways. This technique ensures that the client inhales the medication effectively. Holding the mouthpiece between the lips also prevents the medication from escaping and ensures that it reaches the lungs. E. Some medications delivered via MDIs, especially corticosteroids, can cause oral candidiasis (thrush) or irritation if not rinsed out of the mouth. Rinsing the mouth with water after using the MDI helps reduce the risk of side effects such as thrush or irritation in the mouth and throat. This instruction is particularly important for clients using corticosteroid inhalers. D. MDIs can deliver medications for both quick relief (short-acting bronchodilators) and long-term control (maintenance medications). This instruction is correct if the medication prescribed is a short- acting bronchodilator (e.g., albuterol) used for quick relief of symptoms like wheezing or shortness of breath. However, if the medication is a long-term control medication (e.g., corticosteroid inhaler), it should be used regularly as prescribed to manage underlying inflammation.