A nurse is reviewing the client's medical record in the presurgical holding area. Which assessment finding places the client at an increased risk for surgical site infection?

A. Daily antihypertensive use manages systemic vascular resistance and cardiac output but does not inherently suppress the immune system or impair the primary phases of wound healing. While uncontrolled hypertension can affect overall surgical outcomes, it is not a direct independent risk factor for the colonization of pathogens at the incision site. The nurse should monitor blood pressure stability rather than increased infectious risk. B. A history of deep vein thrombosis increases the client's risk for venous thromboembolism during the perioperative period due to venous stasis and hypercoagulability. However, the presence of a previous clot does not compromise the skin barrier or the cellular response required to prevent a surgical site infection. Prophylaxis for this client would focus on anticoagulation and mechanical compression rather than antimicrobial stewardship. C. Age over 65 years old is associated with physiological changes such as decreased tissue perfusion, thinning of the dermal layer, and a naturally declining immune response known as immunosenescence. These factors collectively hinder the body's ability to clear pathogens and synthesize collagen efficiently at the surgical site. The nurse must recognize that older adults have a statistically higher incidence of postoperative infections compared to younger populations. D. A body mass index of 23 falls within the healthy reference range of 18.5 to 24.9, indicating an appropriate nutritional status and a normal distribution of adipose tissue. Unlike obesity, which impairs blood flow to subcutaneous tissue, or malnutrition, which prevents protein synthesis, a BMI of 23 supports optimal wound healing. This finding actually suggests a lower risk for complications related to surgical site integrity.