Review Question - QID 210866

A 25-year-old woman presents to the psychiatric emergency department in restraints. She was found trying to break into a deli at midnight. The patient claims that she has an idea that will revolutionize the shipping industry. The patient is not violent but seems highly agitated and is speaking very rapidly about her ideas. She is easily distracted and tells you about many of her other ideas. She has a past medical history of depression and hypertension refractory to treatment. Her current medications include captopril, ibuprofen, and melatonin. A neurological exam is deferred due to the patient’s current status. Her pulmonary and cardiovascular exams are within normal limits and mild bilateral bruits are heard over her abdomen. The patient is given haloperidol and diphenhydramine and spends the night in the psychiatric inpatient unit. The patient is started on long-term therapy and is discharged 3 days later. At a follow-up visit with her primary care physician, her temperature is found to be 98.5°F (36.9°C), blood pressure is 150/100 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. She is started on chlorthalidone and instructed to return in 3 days. When the patient returns her blood pressure is 135/90 mmHg. She exhibits a fine tremor and complains of increased urinary frequency. Her pulse is 47/minute, and she is afebrile. Which of the following is the most appropriate next step for this patient?