This album cover is simplistic, featuring a single picture that takes up most of the space like many punk albums. The band name is embroidered onto the nurse's uniform in the picture. The image depicts an unconventional nurse with tattoos and makeup, going against social norms. The layout is simple with just the picture and small text. The image has high contrast to emphasize the makeup, tattoos, and lipstick. The album title "Enema of the State" is a play on words referring to the medical procedure and the film "Enemy of the State". The back cover features the band semi-naked receiving an injection from the nurse, continuing the unconventional medical theme.