A bolus feeding is in progress when the client begins to cough, gag, and vomit. The appropriate action is to:

• A. Continue the administration of the bolus feeding at the same rate
• B. Slow the administration to half the rate and reassess
• C. Pause the feeding to check the tube placement
• D. Discontinue the administration of the bolus feeding

Answer: (D)

When a bolus feeding is underway and the patient begins to cough, gag, or vomit, the immediate concern is the risk of aspiration. Stopping the feeding stops the flow of material into the stomach and, more importantly, into the airway, reducing the chance that gastric contents will be aspirated into the lungs. After discontinuing the feed, assess the patient’s airway and breathing, verify the tube’s placement and patency, and check residuals and symptoms before deciding how to proceed. Continuing at the same rate or slowing the rate does not remove the aspiration risk, and pausing to check placement is a prudent next step, but only after you have stopped the flow to prevent further risk.