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?

A. A history of gastroesophageal reflux disease: GERD increases the likelihood of gastric contents refluxing into the esophagus and potentially being aspirated into the lungs. Clients receiving enteral feedings with impaired lower esophageal sphincter function are at higher risk for aspiration pneumonia, making this a significant risk factor. B. Receiving a high-osmolarity formula: High-osmolarity formulas may cause gastrointestinal discomfort, diarrhea, or delayed gastric emptying, but they do not directly increase aspiration risk if proper feeding techniques and positioning are used. C. A residual of 65 mL 1-hr postprandial: A small gastric residual of 65 mL is generally considered within acceptable limits and does not significantly increase aspiration risk. High residuals (e.g., >250 mL) are more concerning. D. Sitting in high-Fowler's position during the feeding: Maintaining a high-Fowler’s position (60–90°) during enteral feeding reduces aspiration risk by promoting gastric emptying and minimizing reflux. This positioning is protective rather than a risk factor.