Final answer:
Ruthie loses her sketchbook in a car accident, which holds personal and creative significance for her.
Step-by-step explanation:
When Ruthie's family gets into a car accident, the item that she loses is d) Her sketchbook. The loss of her sketchbook is significant to Ruthie as it represents a personal and creative outlet for her. It's not just a collection of drawings; it's a repository of her thoughts, feelings, and artistic development. Therefore, the loss of the sketchbook can have a substantial emotional impact on Ruthie, highlighting the personal value of the item beyond its physical presence.