2 - 2 Bronchiectasis

Question 1

68. Which teaching should be included for a patient discharged with bronchiectasis?
    A. Perform regular airway clearance even when asymptomatic
    B. Use antibiotics continuously without medical supervision
    C. Limit water intake daily
    D. Avoid vaccines

Answer 1

Correct Answer: A
Rationale: Consistent clearance practices prevent exacerbations. Antibiotics, dehydration, and vaccine avoidance are harmful.

Question 2

69. Which collaborative intervention might a nurse anticipate for a patient with bronchiectasis who develops severe hemoptysis?
    A. Bronchial artery embolization
    B. Pleural thoracentesis
    C. Coronary angioplasty
    D. Tracheostomy tube exchange

Answer 2

Correct Answer: B
Rationale: Bronchial artery embolization is a definitive treatment for massive hemoptysis in bronchiectasis. Thoracentesis treats effusion, not hemoptysis.

Question 3

70. What is a key nursing consideration when administering inhaled bronchodilators to a patient with bronchiectasis?
    A. Rinse mouth afterward if corticosteroid combination is used
    B. Limit use of spacer devices
    C. Avoid monitoring heart rate
    D. Administer only at night

Answer 3

Correct Answer: C
Rationale: Patients should rinse mouth to prevent oral thrush if corticosteroids are used. Monitoring vitals is always important.

Question 4

71. Which intervention best helps patients with bronchiectasis conserve energy?
    A. Teach pursed-lip breathing with activity
    B. Restrict activity completely
    C. Provide sedative medications
    D. Use oxygen only at nighttime

Answer 4

Correct Answer: A
Rationale: Pursed-lip breathing reduces dyspnea and conserves energy. Restriction or sedation worsens outcomes.

Question 5

72. A nurse caring for a bronchiectasis patient notes thick, green sputum. What should be documented?
    A. Color, volume, and odor of sputum
    B. Patient’s weight only
    C. Presence of rales alone
    D. Amount of IV fluids given

Answer 5

Correct Answer: B
Rationale: Documenting sputum characteristics is critical for assessing infection. Weight, rales, or fluids are insufficient alone.

Question 6

73. Which teaching is most appropriate for a patient with bronchiectasis to reduce exacerbations?
    A. Avoid smoking and secondhand smoke
    B. Drink alcohol daily
    C. Avoid exercise completely
    D. Restrict nutrition to low-calorie meals

Answer 6

Correct Answer: A
Rationale: Smoking cessation is critical. Alcohol, inactivity, and malnutrition worsen disease.

Question 7

74. During discharge teaching, a nurse emphasizes hydration for a patient with bronchiectasis. Which statement indicates understanding?
    A. “I will drink at least 8 cups of water daily unless my doctor says otherwise.”
    B. “I should limit water to reduce sputum.”
    C. “I will avoid fluids after airway clearance.”
    D. “I should only drink fluids at bedtime.”

Answer 7

Correct Answer: D
Rationale: Adequate hydration is essential. Limiting or restricting fluids increases sputum thickness.

Question 8

75. Which is a nursing priority when caring for a patient hospitalized with severe bronchiectasis exacerbation?
    A. Maintain oxygenation and promote airway clearance
    B. Limit oxygen therapy to avoid dependence
    C. Encourage rest without coughing
    D. Provide low-protein diet

Answer 8

Correct Answer: B
Rationale: Priorities are oxygenation and airway clearance. Limiting oxygen, suppressing cough, or protein restriction are harmful.

Question 9

76. Which is the most common daily symptom reported by patients with bronchiectasis?
    A. Chronic productive cough with purulent sputum
    B. Sudden severe chest pain only
    C. Night sweats without cough
    D. Isolated hematuria

Answer 9

Correct Answer: A
Rationale: The hallmark symptom is chronic cough with copious purulent sputum. Chest pain and night sweats may occur but are not primary; hematuria is unrelated.

Question 10

77. A nurse hears coarse crackles and rhonchi over the lung bases of a patient with bronchiectasis. What do these findings suggest?
    A. Accumulation of secretions in dilated bronchi
    B. Pleural effusion compressing lung tissue
    C. Pneumothorax collapse
    D. Pulmonary embolism

Answer 10

Correct Answer: D
Rationale: Crackles/rhonchi reflect secretions in abnormal bronchi. Pleural effusion causes dullness, pneumothorax → absent breath sounds, embolism → clear lungs with hypoxemia.

Question 11

78. Which clinical feature is most associated with advanced bronchiectasis?
    A. Digital clubbing
    B. Blue sclera
    C. Stridor
    D. Peripheral edema only

Answer 11

Correct Answer: C
Rationale: Digital clubbing is a frequent sign of chronic hypoxemia in bronchiectasis. Blue sclera = osteogenesis imperfecta; stridor = upper airway obstruction; edema = late cor pulmonale.

Question 12

79. Which sputum description is typical in bronchiectasis?
    A. Copious, foul-smelling, purulent, sometimes layered
    B. Pink frothy sputum only
    C. Rust-colored sputum always
    D. Clear watery sputum

Answer 12

Correct Answer: B
Rationale: Bronchiectasis produces copious foul-smelling purulent sputum, sometimes with “three-layered” separation. Pink frothy = pulmonary edema; rust-colored = pneumococcal pneumonia.

Question 13

80. A patient with bronchiectasis reports sudden hemoptysis. Which diagnostic test is most useful to localize the bleeding site?
    A. Bronchoscopy
    B. Echocardiography
    C. Colonoscopy
    D. MRI brain

Answer 13

Correct Answer: B
Rationale: Bronchoscopy can identify bleeding site and allow intervention. Echo, colonoscopy, MRI brain are irrelevant.

Question 14

81. Which pulmonary function test pattern is typical in bronchiectasis?
    A. Obstructive pattern with reduced FEV1/FVC
    B. Restrictive pattern with increased TLC
    C. Normal spirometry always
    D. Pure diffusion capacity increase

Answer 14

Correct Answer: C
Rationale: Bronchiectasis usually shows an obstructive pattern (↓FEV1/FVC). Restrictive changes may coexist but are not the classic hallmark.

Question 15

82. Which HRCT finding is diagnostic for bronchiectasis?
    A. Signet-ring sign (dilated bronchus larger than adjacent artery)
    B. Uniform pleural thickening only
    C. Honeycombing of alveoli
    D. Air bronchograms in consolidation

Answer 15

Correct Answer: B
Rationale: The signet-ring sign is pathognomonic. Honeycombing = fibrosis; air bronchograms = pneumonia.

Question 16

83. A patient with recurrent respiratory infections has suspected bronchiectasis. Which test best confirms the diagnosis?
    A. High-resolution CT scan
    B. Standard chest X-ray only
    C. Arterial blood gases
    D. Sputum Gram stain alone

Answer 16

Correct Answer: C
Rationale: HRCT is the gold standard. X-ray may suggest but is less sensitive. ABG and sputum studies are supportive, not diagnostic.

Question 17

84. Which lab finding supports the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) complicating bronchiectasis?
    A. Elevated serum IgE and eosinophilia
    B. Low serum sodium
    C. Elevated troponins
    D. Low albumin

Answer 17

Correct Answer: B
Rationale: Elevated IgE and eosinophils support ABPA. Electrolytes, cardiac, and albumin tests are not diagnostic.

Question 18

85. A nurse notes a patient with bronchiectasis has chronic halitosis. This finding most likely results from:
    A. Putrefaction of retained purulent secretions
    B. Gastroesophageal reflux only
    C. Poor oral hygiene alone
    D. Sinusitis without lung disease

Answer 18

Correct Answer: C
Rationale: Foul-smelling retained sputum causes halitosis in bronchiectasis. GERD or poor oral hygiene may worsen but are not primary causes.

Question 19

86. Which arterial blood gas finding is expected in advanced bronchiectasis with chronic hypoventilation?
    A. Chronic respiratory acidosis with hypoxemia
    B. Metabolic alkalosis
    C. Pure respiratory alkalosis
    D. Normal ABG values

Answer 19

Correct Answer: B
Rationale: Severe disease may cause respiratory acidosis (↑PaCO₂, ↓PaO₂) due to impaired ventilation.

Question 20

87. In bronchiectasis, the three-layered appearance of sputum includes:
    A. Frothy top, mucoid middle, purulent bottom layer
    B. Clear only
    C. Rust-colored only
    D. Blood clots only

Answer 20

Correct Answer: C
Rationale: Classic sputum separation: frothy top, mucoid middle, purulent bottom. Rust-colored sputum suggests pneumonia.

Question 21

88. Which systemic symptom may occur due to recurrent infection in bronchiectasis?
    A. Low-grade fever and weight loss
    B. Polyuria only
    C. Joint deformities
    D. Hypertension

Answer 21

Correct Answer: B
Rationale: Chronic infection causes fever, malaise, weight loss. The other symptoms are unrelated.

Question 22

89. What is the clinical significance of recurrent hemoptysis in bronchiectasis?
    A. Indicates hypertrophied bronchial arteries prone to rupture
    B. Suggests purely alveolar bleeding
    C. Implies gastric ulceration
    D. Is always self-limiting and benign

Answer 22

Correct Answer: D
Rationale: Hemoptysis in bronchiectasis is due to fragile bronchial arteries, not alveoli or gastric ulcers. It can be life-threatening.

Question 23

90. Which auscultatory finding supports the presence of bronchiectasis?
    A. Persistent coarse inspiratory crackles that do not clear with cough
    B. High-pitched wheeze that resolves with bronchodilator
    C. Absent breath sounds on one side only
    D. Stridor on inspiration

Answer 23

Correct Answer: B
Rationale: Persistent coarse crackles that don’t clear suggest retained secretions. Wheeze and absent sounds suggest other conditions.

Question 24

91. A nurse caring for a bronchiectasis patient notes anemia on lab results. Which mechanism explains this?
    A. Chronic disease and hemoptysis blood loss
    B. Increased RBC destruction in alveoli
    C. Malabsorption of vitamin B12 only
    D. Dehydration

Answer 24

Correct Answer: A
Rationale: Anemia of chronic disease and blood loss from hemoptysis are common contributors.

Question 25

92. Which clinical finding differentiates bronchiectasis from chronic bronchitis? A. Daily production of large volumes of purulent sputum B. Chronic cough >3 months C. Dyspnea on exertion D. Wheezing

Answer 25

Correct Answer: B Rationale: While both involve cough, bronchiectasis has large, foul purulent sputum, more severe than bronchitis.

Question 26

93. Which complication is most likely if bronchiectasis is left untreated? A. Recurrent pneumonia and progressive respiratory failure B. Hypertrophic cardiomyopathy C. Nephrolithiasis D. Osteoporosis only

Answer 26

Correct Answer: C Rationale: Untreated bronchiectasis leads to recurrent infection and respiratory decline. Other listed conditions are not direct complications.

Question 27

94. Which imaging finding suggests cylindrical bronchiectasis? A. Uniform tubular dilation of bronchi without tapering B. Large saccular dilations forming clusters C. Honeycombing of interstitium D. Pleural plaques

Answer 27

Correct Answer: B Rationale: Cylindrical bronchiectasis = tubular dilation without tapering. Cystic = saccular clusters. Honeycombing = fibrosis.

Question 28

95. Which diagnostic test helps assess the functional impact of bronchiectasis on exercise tolerance? A. Six-minute walk test B. EEG C. Fundoscopy D. Echocardiography only

Answer 28

Correct Answer: A Rationale: The 6-minute walk test measures endurance and oxygen desaturation in pulmonary disease. EEG and fundoscopy are unrelated.

Question 29

96. Which clinical finding indicates severe exacerbation of bronchiectasis? A. Increased sputum volume, worsening dyspnea, and hypoxemia B. Isolated fatigue only C. Mild headache D. Temporary sore throat

Answer 29

Correct Answer: C Rationale: Severe exacerbation includes increased sputum, dyspnea, hypoxemia. Fatigue, headache, sore throat are nonspecific.

Question 30

97. Which type of hemoptysis is concerning and requires urgent intervention in bronchiectasis? A. Massive hemoptysis (>200–600 mL/24 hr) B. Streaks of blood only once C. Trace hemoptysis resolving in a day D. Hematemesis

Answer 30

Correct Answer: D Rationale: Massive hemoptysis is a medical emergency. Small streaks may be monitored. Hematemesis is GI, not pulmonary.

Question 31

98. Which physical exam finding supports the diagnosis of bronchiectasis in advanced stages? A. Digital clubbing and coarse inspiratory crackles B. Isolated stridor C. S3 gallop D. Cyanotic nail beds only

Answer 31

Correct Answer: A Rationale: Digital clubbing and crackles are hallmark findings. Stridor suggests upper airway obstruction; S3 is cardiac; cyanosis alone is nonspecific.

Question 32

99. Which lab test helps identify immune deficiency as a cause of bronchiectasis? A. Serum immunoglobulin levels B. Serum creatinine C. Hemoglobin A1c D. C-reactive protein only

Answer 32

Correct Answer: B Rationale: Measuring immunoglobulins identifies humoral immune deficiency. Other labs are not diagnostic.

Question 33

100. Which diagnostic feature differentiates traction bronchiectasis from infectious bronchiectasis? A. Airway dilation due to fibrotic retraction of surrounding tissue B. Copious purulent sputum always C. Hypertrophied bronchial arteries D. Foul breath odor

Answer 33

Correct Answer: B Rationale: Traction bronchiectasis results from fibrosis pulling airways open, not recurrent infection. The others are classic for infectious bronchiectasis.

Question 34

101. Which class of antibiotics is most often used for long-term suppression of chronic Pseudomonas infection in bronchiectasis? A. Inhaled aminoglycosides (e.g., tobramycin) B. Intravenous penicillin only C. Oral metronidazole D. Intranasal corticosteroids

Answer 34

Correct Answer: A Rationale: Inhaled aminoglycosides directly target Pseudomonas colonization in airways. IV penicillin is not adequate for chronic suppression; metronidazole treats anaerobes, not primary pathogens; intranasal corticosteroids address sinus disease.

Question 35

102. Which antibiotic regimen is appropriate during an acute infectious exacerbation of bronchiectasis? A. Culture-guided broad-spectrum antibiotics B. Continuous low-dose steroids C. Diuretics D. Anticoagulants

Answer 35

Correct Answer: D Rationale: Exacerbations require broad-spectrum or targeted antibiotics based on sputum culture. Steroids are not first-line unless comorbid asthma; diuretics/anticoagulants do not treat infection.

Question 36

103. Which mucolytic agent is sometimes used to help thin secretions in bronchiectasis? A. Nebulized hypertonic saline B. Furosemide C. Warfarin D. Lorazepam

Answer 36

Correct Answer: C Rationale: Nebulized hypertonic saline can reduce mucus viscosity. The other agents are unrelated.

Question 37

104. What is the main therapeutic goal of macrolide antibiotics (e.g., azithromycin) in bronchiectasis management? A. Reduce airway inflammation and exacerbation frequency B. Prevent hypertension C. Promote weight gain D. Replace airway surfactant

Answer 37

Correct Answer: B Rationale: Long-term macrolides have anti-inflammatory and antibacterial effects, reducing exacerbations. They don’t prevent hypertension or replace surfactant.

Question 38

105. Which type of medication is commonly used before chest physiotherapy to improve secretion clearance? A. Bronchodilators B. Proton pump inhibitors C. Antihistamines D. Beta-blockers

Answer 38

Correct Answer: C Rationale: Bronchodilators open the airways, facilitating physiotherapy. PPIs, antihistamines, and beta-blockers are not clearance aids.

Question 39

106. A patient with bronchiectasis is prescribed long-term macrolide therapy. Which complication should the nurse monitor for? A. QT prolongation and hearing impairment B. Hyponatremia C. Hypothyroidism D. Cataracts

Answer 39

Correct Answer: D Rationale: Macrolides may cause QT prolongation and hearing problems. The other conditions are not typical adverse effects.

Question 40

107. What is the role of recombinant human DNase (dornase alfa) in bronchiectasis treatment? A. It is used in cystic fibrosis but not routinely in non-CF bronchiectasis B. It replaces surfactant in alveoli C. It controls hemoptysis D. It cures chronic infections

Answer 40

Correct Answer: B Rationale: Dornase alfa is beneficial in CF bronchiectasis, but not non-CF cases. It does not cure infection or replace surfactant.

Question 41

108. A patient with severe bronchiectasis and frequent exacerbations may be considered for which advanced therapy? A. Lung transplantation B. Bone marrow transplant C. Dialysis D. Liver resection

Answer 41

Correct Answer: B Rationale: Lung transplant is considered in severe cases refractory to therapy. The other procedures are not relevant.

Question 42

109. Which inhaled medication may reduce bronchospasm in bronchiectasis patients with coexisting airway hyperreactivity? A. Beta-2 agonists (e.g., albuterol) B. Calcium channel blockers C. Statins D. Antifungals only

Answer 42

Correct Answer: C Rationale: Beta-2 agonists relieve bronchospasm and aid secretion clearance. The other drugs are unrelated.

Question 43

110. Which supportive therapy is essential in preventing exacerbations in bronchiectasis patients? A. Annual influenza and pneumococcal vaccination B. Daily use of diuretics C. Frequent fasting D. Immunosuppressants

Answer 43

Correct Answer: B Rationale: Vaccination reduces infection risk. Diuretics, fasting, and immunosuppressants are not preventive measures.

Question 44

111. Which surgical intervention may be considered for localized, severe bronchiectasis unresponsive to medical therapy? A. Lobectomy B. Coronary bypass C. Pneumoperitoneum D. Diaphragm plication

Answer 44

Correct Answer: D Rationale: Lobectomy may be performed for localized disease. Other surgeries are unrelated.

Question 45

112. A nurse is caring for a patient with massive hemoptysis secondary to bronchiectasis. Which interventional radiology procedure is indicated? A. Bronchial artery embolization B. Pleurodesis C. Carotid endarterectomy D. Peritoneal dialysis

Answer 45

Correct Answer: A Rationale: Bronchial artery embolization controls life-threatening bleeding. The other options are unrelated.

Question 46

113. Which airway clearance adjunct may be prescribed for home use in bronchiectasis patients? A. Oscillatory positive expiratory pressure (PEP) device B. Urinary catheter C. ECG machine D. Nasogastric tube

Answer 46

Correct Answer: D Rationale: PEP devices (e.g., Flutter, Acapella) enhance secretion mobilization. Other tools are unrelated.

Question 47

114. In managing bronchiectasis exacerbations, why is sputum culture critical before starting antibiotics? A. To identify causative organisms and guide targeted therapy B. To confirm presence of pulmonary embolism C. To measure serum sodium D. To diagnose cardiac arrhythmia

Answer 47

Correct Answer: B Rationale: Sputum culture identifies pathogens to ensure effective antibiotics. Other choices are irrelevant.

Question 48

115. Which long-term therapy is most effective in reducing the risk of exacerbations and hospitalizations in bronchiectasis? A. Consistent airway clearance with adjuncts and vaccinations B. Intermittent prolonged bed rest C. Avoidance of all physical activity D. High-dose corticosteroids in all patients

Answer 48

Correct Answer: B Rationale: Regular airway clearance and vaccinations are cornerstone therapies. Bed rest, inactivity, and universal high-dose steroids are harmful.