Abstract Background: Flexible bronchoscopy is frequently required procedure in elderly. Patients under bronchoscopy have complaint fears, discomfort and anxiety. Ann of study: To evaluate the effect of nursing guidelines on knowledge and anxiety level of elderly patients' undergoing bronchoscopy. Patients and Method: A quasi-experimental research design was conducted at Bronchoscopy Unit of Chest Department at Assuit University Hospital. Sample A random sample of 150 elderly patients undergoing bronchoscopy aged 60 years and above. The patients were divided into two equal groups; 75 patients received nursing guidelines (study group); 75 patients did not receive nursing guidelines (control group). Tools: a) An interview sheet, b) Hospital anxiety scale, c) Designed nursing guidelines. Results: 66, 7% & 65, 3% of the control, study group were illiterate and 88% &85.3% were living in rural areas. As regards knowledge scores statistically significant difference about bronchoscope (p-value = p < 0.001**) and the anxiety level of both groups (p < 0.001**). Conclusion: a good improvement in the knowledge scores of elderly patients were found after the implementation of nursing guidelines and the anxiety level were less in study group than in control group. Recommendation: A structured educational program using video containing complete instruction for patient about bronchoscopy.