The advanced practice nurse is caring for a patient in an outpatient clinic who has expressed thoughts of suicide, but who does not have a plan or means in place. The patient tells the nurse, "I sometimes think it would be easier for me to just go to sleep and never wake up. But I don't hurt myself because I love my children too much." Which nursing interventions are most appropriate for this patient? Select all that apply.

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2. The patient is likely in Stage II of the Stage of Severity of Suicide Risk. Stage II is manifested by fleeting thoughts of suicide with no intent to carry out suicidal action. Also, the patient's love of his or her children is a protective measure. Appropriate nursing actions for a patient in Stage II include teaching the use of the National Suicide Prevention Lifeline and encouraging the patient to use internal and external support systems. Placing the patient on constant safety observation, admitting the patient to the behavioral health hospital immediately, and recognizing that the patient is likely to reject teaching are all interventions for patients who are in stages III, IV, and V of the Stage of Severity of Suicide Risk.
4. The patient is likely in Stage II of the Stage of Severity of Suicide Risk. Stage II is manifested by fleeting thoughts of suicide with no intent to carry out suicidal action. Also, the patient's love of his or her children is a protective measure. Appropriate nursing actions for a patient in Stage II include teaching the use of the National Suicide Prevention Lifeline and encouraging the patient to use internal and external support systems. Placing the patient on constant safety observation, admitting the patient to the behavioral health hospital immediately, and recognizing that the patient is likely to reject teaching are all interventions for patients who are in stages III, IV, and V of the Stage of Severity of Suicide Risk.

The Advanced Practice Nurse Is Caring for a Patient in an Outpatient