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An 85-Year-Old Woman Comes to the Office for Follow-Up of Chronic

question 245

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An 85-year-old woman comes to the office for follow-up of chronic conditions. She has occasional knee pain due to osteoarthritis, for which she takes ibuprofen. The patient also has a history of hypertension treated with amlodipine; her blood pressure had been well controlled in the past, but several readings over the past year have been high. She insists that she takes her medications as prescribed, but pharmacy records indicate that she has not picked up her medication on several occasions. The patient's husband passed away a year ago, and since then she has lived with a family friend to share expenses. She has no difficulty cooking, cleaning, dressing, or bathing. She cries sometimes when she thinks about him, but she also enjoys memories of good times they had together.
Temperature is 36.7 C (98 F) , blood pressure is 162/96 mm Hg, pulse is 78/min, and respirations are 12/min. Examination shows no swelling or warmth of the joints. There is a small effusion in the right knee and mild restriction on extension of both knees. There is no joint laxity or instability. The remainder of the examination is unremarkable.
Which of the following is the most appropriate next step in management of this patient?

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