The Advanced Practice Registered Nurse (APRN) sees a patient in the primary care office for a routine physical exam. The patient reports suicidal thoughts. What is the APRN's most appropriate next step?

Assessment of suicidal ideation in a primary care setting requires immediate, structured evaluation of the patient’s level of risk. Suicidal thoughts range from passive ideation to active intent with a specific plan and means. The priority is to determine the severity, immediacy, and specificity of the risk before initiating referrals or treatment. This ensures patient safety and guides the urgency of intervention. Rationale: A. Notifying the patient’s family without the patient’s consent is not the appropriate first step unless there is imminent danger and the patient is at high risk of harm. Confidentiality must be maintained while conducting a proper risk assessment. Premature disclosure may also damage trust and hinder therapeutic communication. B. Referring the patient to a psychologist is an important part of long-term management but is not the immediate priority when suicidal ideation is newly identified. The APRN must first assess the severity of risk to determine whether urgent emergency intervention is required. Referral decisions depend on the outcome of a thorough suicide risk evaluation. C. Prescribing a selective serotonin reuptake inhibitor such as an antidepressant is not the immediate intervention in the context of active suicidal ideation without prior risk assessment. Antidepressants take weeks to become effective and may initially increase energy before mood improves, which can increase risk in some patients. Immediate safety assessment must occur first. D. The most appropriate next step is to directly assess suicide risk by asking about a specific plan, including when, where, and how the patient would act on the thoughts. This determines the level of risk (low, moderate, or high) and guides urgent management decisions such as safety planning or emergency hospitalization. It is a critical step in ensuring immediate patient safety.