Review Question - QID 109867

A 29-year-old woman comes to her primary care physician hoping she is pregnant. She had been taking oral contraceptive pills, but stopped when she began trying to get pregnant 7 months ago. Since then, she has not had her period. She took a few home pregnancy tests that were negative, but she feels they could be wrong. She has gained 4 lbs in the past month, and her breasts feel full. Today, she expressed milk from her nipples. She complains of fatigue, which she attributes to stress at work, and headaches, to which she says “my sister told me she had headaches when she was pregnant.” She denies spotting or vaginal discharge. Her last menstrual period was at age 22, prior to starting oral contraceptive pills. Her medical and surgical history are not significant. She has no history of sexually transmitted infections. She and her husband are having intercourse 3-4 times a week. Her family history is significant for breast cancer in her mother and an aunt who died of ovarian cancer at 55. Her temperature is 98.6°F (37°C), blood pressure is 115/73 mmHg, pulse is 62/min, respirations are 12/min, and oxygen saturation is 99% on room air. On physical examination, no breast masses are appreciated, but compression of the nipples produces whitish discharge bilaterally. A bimanual pelvic examination is normal. A urine pregnancy test is negative. Which of the following is the most appropriate initial step in management for this patient?