A nurse is caring for a client who is receiving continuous enteral feedings. Which of the following actions should the nurse take? (Select all that apply.)

A. Maintain the head of the client's bed at a 30° angle or higher: Elevating the head of the bed to at least 30° reduces the risk of aspiration by preventing reflux of gastric contents into the airway, which is a critical safety measure during continuous enteral feedings. B. Change the feeding container and tubing every 24 hr: For continuous feedings using an open system, the container and tubing should be changed every 4–8 hours to reduce the risk of bacterial contamination. Changing only every 24 hours increases infection risk. C. Ensure the formula is cold before administration: Enteral formulas should be at room temperature before administration to prevent gastrointestinal discomfort and cramping. Cold formula can cause nausea, abdominal pain, and delayed gastric emptying. D. Check gastric residuals every 4 hr: Monitoring gastric residuals every 4 hours helps assess feeding tolerance, detect delayed gastric emptying, and reduce the risk of aspiration. This is standard practice for continuous enteral feedings. E. Check placement of the feeding tube by x-ray once daily: Tube placement should be confirmed by x-ray initially after insertion and as clinically indicated, not daily. Daily x-rays are unnecessary and expose the client to excessive radiation.