# A school nurse conducts a confidential wellness visit with a 16-year-old using the HEEADSSS psychosocial assessment. Which risk-reduction actions are appropriate? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368298&lang=en  
> language: en  
> subject: Assignment/Delegation/Supervision  
> category: HPM

## Question

A school nurse conducts a confidential wellness visit with a 16-year-old using the HEEADSSS psychosocial assessment. Which risk-reduction actions are appropriate? Select all that apply.

1

Explain confidentiality and its limits at the start, including required action for imminent danger or suspected abuse

2

Require a parent or guardian to remain for the complete interview so that answers to psychosocial questions can be confirmed and recorded with the adult present

3

Wait for the adolescent to initiate any discussion of sexually transmitted infections and contraception because raising these subjects during routine screening could cause discomfort

4

Provide age-appropriate counseling on tobacco, vaping, alcohol, and substance use with motivational interviewing

5

Screen for depression and suicide risk with a validated tool and establish a safety plan and referral when indicated

6

Counsel on seat belt use, avoiding impaired driving or riding, and not texting while driving

## Explanation

Explain confidentiality and its legal limits first to build trust (Choice 1). Provide private one-to-one time for sensitive topics rather than requiring a parent throughout (Choice 2). Proactively address STI prevention and contraception rather than waiting for the adolescent to ask (Choice 3). Counsel about tobacco, vaping, alcohol, and substances using motivational interviewing (Choice 4). Use validated depression and suicide screening with a safety plan and referral when indicated (Choice 5), and address seat belts, impaired driving or riding, and texting while driving (Choice 6).

## In-depth explanation

HEEADSSS Framework
Confidential adolescent psychosocial assessment:
- Home environment
- Education/Employment
- Eating
- Activities
- Drugs (tobacco/vaping/alcohol/illicit)
- Sexuality
- Suicide/depression
- Safety (violence/seat belts)

Confidentiality Frame
Open the visit with: "What we discuss is private, EXCEPT if I learn you are in danger of hurting yourself, hurting someone else, or someone is hurting you — those I must report."

Top Adolescent Mortality Causes
1. Unintentional injury (motor vehicle dominant) — seat belts, impaired/distracted driving
2. Suicide — PHQ-9 modified for teens, safety plan
3. Homicide — violence/safety
4. Substance overdose — tobacco/vaping/alcohol/opioids

Counseling Style
- Motivational interviewing: open-ended questions, affirmations, reflection, summary
- Strengths-based, non-judgmental
- Provide brief anticipatory guidance even if no concern raised

Memory Tip
"Confidentiality first; HEEADSSS; MI counseling; Screen depression/suicide"

## Clinical scenario

Scenario
School nurse, 16 yo well visit, using HEEADSSS framework.

Visit Flow
1. Open with confidentiality limits
2. 1:1 time without parent for sensitive topics
3. Risk-reduction counseling: seat belts, impaired/distracted driving, tobacco/vaping, alcohol/substance, sexuality/STI/contraception
4. Depression/suicide screen (PHQ-9 modified) + safety plan
5. Strengths-based MI
6. Provide proactive guidance — do not wait for the teen to raise topics

Avoid
- Requiring parent present for confidential topics
- Deferring STI/contraception until client raises
- Lecturing or shaming

## Key concepts

- **HEEADSSS Adolescent Psychosocial Assessment** — Validated framework for confidential 1:1 adolescent psychosocial assessment: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety. Conducted privately without parent for sensitive items. Begins with explicit confidentiality framing including its limits (imminent self-harm, harm to others, abuse mandate reporting). Identifies risk and protective factors and guides anticipatory guidance.
- **Confidentiality in Adolescent Care** — Adolescents have legal and ethical entitlement to confidential care for many sensitive issues (varies by state and topic — commonly STI testing/treatment, contraception, mental health, substance use). Required disclosures: imminent risk of self-harm, imminent harm to others, and child abuse. Nurses open visits by stating confidentiality and its limits, then dedicate 1:1 time without the parent. Forcing parental presence for sensitive topics is a barrier to disclosure and care.
- **Adolescent Mortality and Risk Counseling Priorities** — Top adolescent mortality causes in the U.S.: unintentional injury (predominantly motor vehicle), suicide, and homicide. Anticipatory counseling priorities: consistent seat belt use, no impaired or distracted driving, helmet use, firearms safety; depression and suicide screening with validated tools and safety planning; tobacco, e-cigarette/vaping, alcohol, and other substance use using motivational interviewing; sexuality with STI prevention and contraception; healthy eating, activity, sleep. Nurses provide proactive guidance regardless of whether the adolescent raises the topic.

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