Which client responses does the nurse determine represent the highest risk for the development of pressure ulcers? a. Incontinence and inability to move independently.b. Periodic diaphoresis and occasional sliding down in bed.c. Reaction to just painful stimuli and receiving tube feedings.d. Adequate nutritional intake and spending extensive time in a wheelchair.

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1. Which client responses does the nurse determine represent the highest risk for the development of pressure ulcers?

a. Incontinence and inability to move independently.

b. Periodic diaphoresis and occasional sliding down in bed.

c. Reaction to just painful stimuli and receiving tube feedings.

d. Adequate nutritional intake and spending extensive time in a wheelchair.