PurposeTo explore current studies on metabolic syndrome (MetS), including its complex pathophysiology and to describe the unique role of the advanced practice nurse including management and ethical decision making utilizing a case study to exemplify salient points. Data sourcesFrom original research articles extracted from nursing and medical databases. ConclusionsMetS is a constellation of characteristics that increases the risk for the development of diabetes and cardiovascular disease. The pathophysiology of MetS is not completely understood, but is thought to involve a complex interaction between the environment, genetic susceptibility, insulin resistance, and abnormal adipose tissue function. Implications for practiceThe role of the advanced practice nurse is appropriate for early intervention and counseling of patients with MetS and those who are at risk, as well as addressing the ethical challenges that accompany their care.