A nurse is teaching a client who is receiving enteral nutrition via bolus feedings. Which of the following statements by the client indicates an understanding of the teaching?

A. Elevate the head of the bed: Raising the head of the bed to at least 30 to 45 degrees is the first and most essential action to reduce the risk of aspiration during enteral feeding. This position helps ensure that the formula flows into the stomach by gravity and minimizes the potential for reflux of gastric contents into the lungs, which can lead to aspiration pneumonia.
B. Attach the barrel of the syringe to the tube after removing the plunger: This step is necessary for gravity-based enteral feeding when using a syringe. However, it should only be done after confirming tube placement and ensuring the patient is positioned properly. Attaching the syringe before proper safety precautions increases the risk of aspiration.
C. Insert air into the tube before pulling back gastric contents: Injecting air into the gastrostomy tube is part of the verification process to confirm tube placement, often followed by aspirating gastric contents. While this is important, it is not the very first action. The client's head must be elevated first to ensure safety before any manipulation of the tube begins.
D. Flush the tube with 30 mL water: Flushing is necessary to ensure tube patency and to prevent blockage before and after feedings. However, it is not the first step in the procedure. Elevating the head of the bed comes before flushing to prevent aspiration during any subsequent feeding or fluid administration.

A. "Provide a small feeding just before bedtime." Feeding just before bedtime can increase the risk of reflux during sleep due to a full stomach and recumbent positioning. It is better to allow time for digestion before lying down to reduce reflux episodes.
B. "Position the newborn at a 20-degree angle after feeding." Keeping the newborn in an upright or slightly elevated position (typically 20 to 30 degrees) after feeding helps reduce gastroesophageal reflux by using gravity to prevent stomach contents from flowing back into the esophagus.
C. "Place the newborn in a side-lying position if vomiting." Side-lying is not the recommended sleeping or resting position due to the risk of sudden infant death syndrome (SIDS). The safest position for infants is on the back, even if they have reflux.
D. "Dilute formula with 1 tablespoon of water." Diluting formula can lead to electrolyte imbalances and inadequate caloric intake. Formula should be prepared according to manufacturer or provider instructions to ensure nutritional needs are met.