When a sexting message spreads to an unintended audience, it can adversely affect the victim's reputation. Sexting incidents constitute a potential school safety risk. Just as with other types of adolescent risk behavior, school nurses might have to initiate the first response when a sexting episode arises, but a school nurse's role goes beyond intervention. They can also play an important role in the prevention of sexting and its related risks. This article reviews the links between adolescent sexting, other types of risk behavior, and its emotional and psychosocial conditions. Seven databases were examined and nine studies remained for further review. The review of the literature shows that adolescent sexting is cross sectionally associated with a range of health-risk behaviors. Youth who engage in sexting are also found to experience peer pressure and a range of emotional difficulties. The results can guide school nurse education and practice.