What should be done for a 68-year-old smoker with a history of hypertension who experienced dizziness and fainting while mowing the lawn, but feels fine now?

The most appropriate action in this scenario is to perform a complete neurological and cardiac exam. Given the patient's age, smoking history, and the recent incident of dizziness and fainting, it is essential to thoroughly evaluate both the neurological and cardiovascular systems. These factors can indicate serious underlying conditions such as transient ischemic attacks, arrhythmias, or other cardiovascular issues.

The history of dizziness and fainting, especially in an older adult, raises concerns about potential neurological events or cardiovascular problems, making a comprehensive exam critical. Investigating both systems can help identify whether the fainting spell was due to a fall in blood pressure, arrhythmia, or a neurological cause, all of which require different management approaches.

While a follow-up appointment might seem reasonable, it lacks the immediacy needed to address the potential acute causes of the patient’s symptoms. Likewise, stress testing may be useful in assessing cardiac function and capacity but is not the first step in evaluating an acute symptomatic event. And though prescribing antihypertensive medication might be part of managing the patient's hypertension, starting or adjusting medication without first determining the cause of the dizziness is premature and could be unsafe, especially if the fainting is due to low blood pressure or another cardiovascular problem.