Two weeks ago, a soldier returned to the United States from active duty in a combat zone. The soldier was diagnosed with post-traumatic stress disorder (PTSD). Which comment by the soldier requires the nurse's immediate attention?

A. Concerns about returning to school reflect normal adjustment issues and do not indicate immediate danger. B. Expressing happiness about being home is a positive statement and does not require urgent intervention. C. Hypervigilance and startle responses are common symptoms of PTSD and should be monitored but are not immediately life-threatening. D. Expressions of survivor’s guilt or thoughts questioning why one survived while others did not can indicate severe emotional distress and possible risk for self-harm or suicidal ideation. This statement requires immediate assessment and intervention by the nurse.