A client with dysphagia (difficulty swallowing) is at risk for aspiration. Which nursing action is highest priority at mealtimes?

ASPIRATION PRECAUTIONS: POSITIONING: 90° upright (not just slightly elevated) during and 30-45 min after meals — gravity assists swallowing and reduces reflux/aspiration risk; THICKENED LIQUIDS: Thin liquids are the most dangerous for dysphagia — thickening agents (nectar, honey, pudding consistency) as ordered by speech therapy; PACE: Small bites, allow full swallow before next bite, no rushing; SUCTION: Available at bedside in case of aspiration; MONITORING: Watch for coughing, choking, wet/gurgly voice quality after swallowing (sign of aspiration); SPEECH THERAPY: Dysphagia evaluation and specific dietary texture orders should be coordinated with SLP; PN SCOPE: Implement and monitor aspiration precautions; report changes to RN; do not independently modify diet consistency orders.