مريض تليف كبد عنده دوالي في المريء. أي سلوك يرفع خطر النزيف؟

A client with cirrhosis has oesophageal varices. Which behaviour increases bleeding risk?

1. Taking a prescribed beta-blocker
2. Eating several small soft meals a day
3. Sleeping with the head slightly raised on two pillows
4. Straining hard at stool and lifting heavy objects

Answer: D) Straining hard at stool and lifting heavy objects. Anything raising abdominal or thoracic pressure (straining, lifting, forceful coughing, vomiting) can rupture varices. Stool softeners and avoiding alcohol and NSAIDs are advised.