A nurse is planning care for a client who is receiving continuous enteral tube feedings through an open system. Which of the following interventions should the nurse include in the plan of care?

A. Check for gastric residual every 12 hr: Current best practices recommend checking gastric residuals every 4–6 hours for continuous feedings to assess tolerance and prevent aspiration. Checking only every 12 hours may delay recognition of feeding intolerance. B. Place enough formula in the container to last 18 hr: Open system formulas should be changed every 4–8 hours to reduce the risk of bacterial contamination. Using formula for 18 hours increases the risk of infection and is not recommended. C. Maintain bed elevation at 20°: To reduce the risk of aspiration, clients receiving continuous enteral feedings should have the head of the bed elevated to 30–45°, not 20°. Proper elevation helps prevent reflux and aspiration pneumonia. D. Flush the tubing with 30 mL of water every 4 hr: Regular flushing maintains tube patency, prevents clogging, and ensures the client receives the full feeding. Flushing every 4 hours with water is consistent with safe enteral feeding practices.