A nurse is caring for a client who is receiving intermittent enteral tube feedings. Which of the following factors places the client at risk for aspiration?

Gastroesophageal reflux disease (GERD) increases aspiration risk because the lower esophageal sphincter allows gastric contents to reflux into the esophagus and potentially the airway. A residual of 65 mL at 1 hr post-feeding may be acceptable depending on facility protocol. High-Fowler's position is protective against aspiration — it is recommended during feedings. High-osmolarity formula may cause diarrhea but does not directly increase aspiration risk.