A patient receiving bolus feeding via nasogastric tube develops sudden coughing and shortness of breath during administration. The nurse's immediate action should be:

• A. Elevate the head of bed and resume feeding
• B. Check placement and resume if normal
• C. Stop the feeding temporarily and reassess
• D. Discontinue the administration of the bolus feeding

Answer: (D)

Sudden coughing and shortness of breath during a nasogastric bolus feeding point to possible aspiration of the formula, so the first priority is protecting the airway and ensuring adequate breathing. Stop the feeding immediately to prevent more volume from entering the airway. Then assess the patient’s respiratory status, place them upright or elevate the head of the bed to reduce aspiration risk, assess oxygenation, listen to the lungs, and monitor for signs of distress. If needed, suction may be used and the tube checked for proper placement, but feeding should not be resumed until the airway and breathing are stabilized and a clinician provides further orders. Discontinuing the bolus feeding addresses the immediate risk; once the patient is stabilized, a reassessment can determine whether and how to proceed with feeding or to switch to an alternative feeding plan.