43. A nurse is reinforcing teaching about use of a metered-dose inhaler (MDI) 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. Shake the canister 3 to 5 seconds vigorously.
Before each use, it's important to shake the MDI to ensure proper mixing of the medication.
B. Place her lips firmly around the mouthpiece.
Creating a tight seal around the mouthpiece ensures that the medication is delivered directly into the airways.
C. Inhale slowly over 3 to 5 seconds while pushing down on the canister.
While pressing down on the canister, the client should inhale slowly to allow the medication to reach the lungs.
D. Hold her breath for 10 seconds.
After inhaling the medication, holding the breath for 10 seconds allows for better absorption of the medication into the lungs.
E. Exhale slowly through pursed lips.
After holding the breath, exhaling slowly through pursed lips helps to fully exhale and ensures that the medication remains in the airways.

B. Beta-blocking medications, such as propranolol and metoprolol, can worsen asthma symptoms in some individuals by constricting the airways. Patients with asthma should avoid or use caution with beta-blockers, especially non-selective ones, as they can trigger or exacerbate asthma attacks.
C. Exposure to secondhand smoke is a well-established trigger for asthma symptoms and can exacerbate respiratory inflammation and airway hyperresponsiveness. Patients with asthma should avoid exposure to secondhand smoke whenever possible to reduce the risk of asthma exacerbations.
D. Carpeting and drapes can harbor dust mites, pet dander, and other allergens that can trigger asthma symptoms in susceptible individuals. Patients with asthma may benefit from removing carpeting and minimizing soft furnishings in the bedroom to reduce exposure to allergens and improve air quality.
E. Pets, particularly those with fur or feathers, can be potent allergens for individuals with asthma. Patients with asthma should consider removing pets from the home or at least keeping them out of the bedroom to minimize exposure to pet dander.
A. Cardiovascular exercise can trigger asthma symptoms in some individuals but it is not typically recommended to eliminate exercise altogether. Instead, patients with asthma should be encouraged to engage in physical activities that are well-tolerated and to use appropriate preventive measures, such as pre-exercise bronchodilator therapy and warm-up exercises, to minimize symptoms.