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. High-osmolarity formulas can cause gastrointestinal distress, but they do not directly increase the risk of aspiration. B. A residual of 65 mL is a normal finding and does not increase the risk of aspiration. C. Sitting in a high-Fowler's position helps reduce the risk of aspiration by allowing gravity to assist with digestion. D. A history of gastroesophageal reflux disease (GERD) can increase the risk of aspiration because it may lead to reflux of gastric contents into the esophagus, which can be inhaled into the lungs.