# A nurse is performing a HEEADSSS psychosocial assessment with a 15-year-old at a wellness visit. The parent has stepped out. Which actions reflect adolescent-appropriate confidentiality practice? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374938&lang=en  
> language: en  
> subject: Health Promotion and Maintenance  
> category: HPM

## Question

A nurse is performing a HEEADSSS psychosocial assessment with a 15-year-old at a wellness visit. The parent has stepped out. Which actions reflect adolescent-appropriate confidentiality practice? Select all that apply.

1

Explain the limits of confidentiality at the START of the conversation: information stays private EXCEPT in cases of imminent harm to self or others, or active abuse situations.

2

If the adolescent reports active suicidal ideation with plan, disclose to the parent and provider, document, and arrange immediate safety evaluation — confidentiality limits apply.

3

Most U.S. states allow minors to consent confidentially to STI testing/treatment, contraception, mental health, and substance use treatment WITHOUT parental notification.

4

Use the HEEADSSS framework to systematically screen risk areas; start with less sensitive topics and progress to more sensitive ones.

5

After the HEEADSSS assessment, inform the parent about any risky behaviors disclosed because the parent is legally responsible for the adolescent's well-being and medical consent.

## Explanation

Adolescent confidentiality: explain limits UP FRONT, recognize state minor-consent laws (STI/contraception/mental health/substance use vary by state but generally protected), use HEEADSSS systematically (less to more sensitive), and disclose ONLY when imminent harm to self/others or active abuse — confidentiality limits explained from the start. Choice 5 violates trust and confidentiality and would prevent honest answers.

## In-depth explanation

Two adolescent NCLEX traps: (1) "tell parents everything" — wrong, breaks trust; (2) "confidentiality is absolute" — wrong, limits apply for imminent harm/abuse. Explaining limits AT THE START is the ethical foundation. State-by-state minor consent laws vary (typically all 50 states allow STI/contraception consent without parents, but mental health and substance use vary).

## Clinical scenario

**15-year-old at wellness visit**. Parent stepped out for the psychosocial portion of the visit. Nurse performs **HEEADSSS assessment** (Home·Education·Eating·Activities·Drugs·Sexuality·Suicide·Safety) and discusses confidentiality.

## Key concepts

- **HEEADSSS assessment** — Home·Education·Eating·Activities·Drugs·Sexuality·Suicide·Safety — adolescent psychosocial framework starting with less sensitive topics.
- **Minor consent laws** — State laws allowing minors to consent without parental notification for STI testing/treatment, contraception, mental health, substance use; vary by state.
- **Confidentiality limits** — Imminent harm to self or others, active abuse, life-threatening — must disclose; explained at start of conversation.

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