Pre-participation physical exams (PPEs) hold great potential for addressing adolescents' health-risk behaviors. School nurses may be well positioned to assist with PPEs, yet little is known about their involvement. In this mixed methods study conducted in 2015, we collected data from school nurses in Texas (surveys, n = 208; key informant interviews, n = 10) to explore their roles and attitudes toward being involved in PPEs and addressing health-risk behaviors. Most respondents described minimal involvement in PPEs or were not involved to their full scope of practice. Most (69%) felt that school nurses are an untapped resource for addressing health-risk behaviors among student athletes. Interview participants felt that student athletes saw nurses as a "safe space" to talk about health-risk behaviors. Barriers included a lack of time, resources for follow-up, parental approval, and legal concerns. Study findings identify potential opportunities to support nurses' involvement in addressing health-risk behaviors among student athletes.