A soldier returns to the United States after active duty in a combat zone and is diagnosed with posttraumatic stress disorder (PTSD). When planning care, which of the following should the nurse identify as the highest priority for screening?

A. Risk for substance use as a coping mechanism: While substance use is a common comorbidity in PTSD and should be assessed, it is not the immediate life-threatening concern. Screening can occur after addressing acute safety risks. B. Sleep disturbances and recurring nightmares: Sleep issues and nightmares are common symptoms of PTSD and affect quality of life, but they do not pose an immediate threat to the client’s safety, making them a lower priority for initial screening. C. Suicidal ideation and risk for self-harm: The highest priority is assessing for suicidal thoughts and self-harm risk because these pose an immediate danger to the client’s life. Early identification is critical to implement safety measures and prevent potentially fatal outcomes. D. Social isolation and withdrawal from family: Social withdrawal is an important psychosocial concern and affects long-term recovery, but it does not present an immediate threat to safety and is a lower-priority screening focus compared with suicide risk.