If gastric residual volume collected before a bolus feeding is greater than 200 mL on two consecutive checks, the nurse should:

• A. Increase the bolus volume
• B. Discontinue the administration of the bolus feeding
• C. Continue with a smaller bolus
• D. Check placement and consult

Answer: (B)

High gastric residual volume before a bolus feed indicates the stomach isn’t emptying properly and the patient isn’t tolerating the feeding. When two consecutive checks show more than 200 mL, continuing the bolus feed increases the risk of regurgitation and aspiration with the next delivery. The safest course is to discontinue the bolus feeding and reassess the patient, looking for causes of delayed gastric emptying (such as medications, dehydration, ileus, or electrolyte disturbances) and confirming tube placement if needed. After stopping, the care plan can be adjusted—often switching to a slower or continuous feeding approach or resuming bolus feeds only after stabilization and physician guidance.

Increasing the bolus volume or continuing with a smaller bolus would not address the intolerance and could worsen the situation. Checking placement and consulting are prudent steps, but the immediate, safest action when two consecutive high residuals occur is to stop the bolus feeding.