Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
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LATEST UPDATE 2022.
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,Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
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LATEST UPDATE 2022. ,,,, ,,,, ,,,,
Maternity &Women’s Health Care 12th Edition LowdermilkTest Bank ,,,, , ,,,, ,,,, ,,, ,,,, ,,,, , ,,,,
Chapter1: 21st CenturyMaternityand Women’s Health Nursing , ,,,, ,,, , ,, ,,,, ,,, , ,,,,
MULTIPLE CHOICE ,,,,
1. In evaluating the level of a pregnant womans risk of having a low-birth-weight (LBW) infant,
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which factor is the most important for the nurse to consider?
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a. African-American race ,,,
b. Cigarette smoking , ,,
c. Poor nutritional status ,,,, ,,,, ,,,, ,,,,
d. Limited maternal education ,,,, ,,,, ,,,, ,,,,
ANS: A ,,,, ,,,,
For African-American births, the incidence of LBW infants is twice that of Caucasian births.
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Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant
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mortalityrates, but it is not the most important. Additionally, smoking is a modifiable risk factor.
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Poor nutrition is an important factor in potential infant mortality rates, but it is not the most
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important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,,
important factor in potential infant mortality rates, but it is not the most important. ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
Additionally, maternal education is a modifiable risk factor. , ,,, ,, ,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, , ,,, ,, ,, ,,,, ,,,, ,,, , ,,,,
DIF: Cognitive Level: Understand REF: IM:
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TOP: Nursing Process: Assessment
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MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care
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2. What is the primaryrole of practicing nurses in the research process?
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a. Designing research studies ,,, ,,,, ,,,,
b. Collectingdata for other researchers , ,,,, ,,,, ,, ,, ,,,, ,,,
c. Identifyingresearchable problems , ,,,, ,,,,
d. Seeking funding to support research studies ,,,,,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
ANS: C ,,,, ,,,,
,Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
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LATEST UPDATE 2022. ,,,, ,,,, ,,,,
When problems are identified, research can be properly conducted. Research of health care
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issues leads to evidence-based practice guidelines. Designing research studies is onlyone factor
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of the research process. Data collection is another factor of research. Financial support is
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necessaryto conduct research, but it is not the primary role of the nurse in the research process. , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,, , ,,, , ,, ,, ,,,, ,,,, ,,,,
DIF: Cognitive Level: Understand REF: im: 14 TOP: Nursing Process:
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N/AMSC: Client Needs: Safe and Effective Care Environment
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3. A 23-year-old African-American woman is pregnant with her first child. Based on the
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statistics for infant mortality, which plan is most important for the nurse to implement? ,,,, ,,,, ,,, ,,,, ,,,, ,,,, , ,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,
a. Perform a nutrition assessment. ,,,, ,,,, ,,,, ,,, ,,,, ,,,,
b. Refer the woman to a social worker. ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
c. Advise the woman to see an obstetrician, not a midwife. ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
d. Explain to the woman the importance of keeping her prenatal care appointments. ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
ANS: D ,,,, ,,,,
Consistent prenatal care is the best method of preventing or controlling risk factors associated ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,,
with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the
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most important action a nurse should take in this situation. The client mayneed assistance from a
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social worker at some time during her pregnancy, but a referral to a social worker is not the
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most important aspect the nurse should address at this time. If the woman has identifiable high-
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risk problems, then her health care may need to be provided by a physician. However, it
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cannot be assumed that all African-American women have high-risk issues. In addition,
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advising the woman to see an obstetrician is not the most important aspect on which the nurse
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should focus atthis time, and it is not appropriate for a nurse to advise or manage the type of
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care a client is to receive.
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DIF: Cognitive Level: Understand REF: IM: TOP: Nursing Process: Planning
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MSC: Client Needs: Health Promotion and Maintenance ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,
4. During a prenatal intake interview, the nurse is in the process of obtaining an initial ,,, , ,,,, ,,,, ,,,, ,, ,, ,,, , ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, , , ,, , ,,, ,,, , ,,,, ,,,, ,, ,, ,,, , ,, ,, ,,, , ,,,, ,,,, ,,,, ,, ,, , ,,, , ,,,
assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the ,,,, ,,,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,
most important for the nurse to perform?
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a. Use maternityjargon to enable the client to become familiar with these terms. ,,, ,, , ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
, Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
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LATEST UPDATE 2022. ,,,, ,,,, ,,,,
b. Speak quickly and efficientlyto expedite the visit. ,,,, ,,,, ,,, ,, ,,,, ,,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
c. Provide the client with handouts. ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
d. Assess whether the client understands the discussion. ,,,, ,,,, ,,,, ,,, ,,,, ,, ,, ,, , ,,, ,,,, ,,,, ,,,, ,,,,
ANS: D ,,,, ,,,,
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
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evaluating whether the client understands the discussion. Speaking slowly and clearly and ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,, ,, ,,, ,
focusing on what is important will increase understanding. Most client education materials are
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written at a level too high for the average adult and may not be useful for a client with
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limitedEnglish proficiency. , ,, ,, ,,,,
DIF: Cognitive Level: ApplyREF: im: 5 TOP: Nursing Process: Evaluation
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MSC: Client Needs: Health Promotion and Maintenance
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5. The nurses working at a newly established birthing center have begun to compare their
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performance in providing maternal-newborn care against clinical standards. This comparison ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,
process is most commonly known as what? ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,,,,,, , ,,, ,, ,, ,,,, ,,,,
a. Best practices network ,,,,, ,,,, ,,,,
b. Clinical benchmarking ,,,,,
c. Outcomes-oriented practice ,,,,,,
d. Evidence-based practice ,,,, ,,,, ,
ANS: C ,,,, ,,,,
Outcomes-oriented practice measures the effectiveness of the interventions and quality of care ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,, ,
against benchmarks or standards. The term best practice refers to a program or service that has
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been recognized for its excellence. Clinical benchmarking is a process used to compare ones
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ownperformance against the performance of the best in an area of service. The term evidence-
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based practice refers to the provision of care based on evidence gained through research and
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clinical trials. , ,,, ,, ,,
DIF: Cognitive Level: Understand REF: im: 11 TOP: Nursing Process:
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EvaluationMSC: Client Needs: Safe and Effective Care Environment , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
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LATEST UPDATE 2022.
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,,,,
,Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,,
LATEST UPDATE 2022. ,,,, ,,,, ,,,,
Maternity &Women’s Health Care 12th Edition LowdermilkTest Bank ,,,, , ,,,, ,,,, ,,, ,,,, ,,,, , ,,,,
Chapter1: 21st CenturyMaternityand Women’s Health Nursing , ,,,, ,,, , ,, ,,,, ,,, , ,,,,
MULTIPLE CHOICE ,,,,
1. In evaluating the level of a pregnant womans risk of having a low-birth-weight (LBW) infant,
,,, , ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, ,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,
which factor is the most important for the nurse to consider?
,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,,
a. African-American race ,,,
b. Cigarette smoking , ,,
c. Poor nutritional status ,,,, ,,,, ,,,, ,,,,
d. Limited maternal education ,,,, ,,,, ,,,, ,,,,
ANS: A ,,,, ,,,,
For African-American births, the incidence of LBW infants is twice that of Caucasian births.
,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,, ,, ,,,, ,,,, , ,,,
Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant
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mortalityrates, but it is not the most important. Additionally, smoking is a modifiable risk factor.
, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,
Poor nutrition is an important factor in potential infant mortality rates, but it is not the most
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important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,,
important factor in potential infant mortality rates, but it is not the most important. ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
Additionally, maternal education is a modifiable risk factor. , ,,, ,, ,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, , ,,, ,, ,, ,,,, ,,,, ,,, , ,,,,
DIF: Cognitive Level: Understand REF: IM:
,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
TOP: Nursing Process: Assessment
,,,, ,,,, ,,,,,,,, ,,,, ,,,,
MSC: Client Needs: Health Promotion and Maintenance, Antepartum Care
,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,,,, ,,,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
2. What is the primaryrole of practicing nurses in the research process?
,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, , ,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,,
a. Designing research studies ,,, ,,,, ,,,,
b. Collectingdata for other researchers , ,,,, ,,,, ,, ,, ,,,, ,,,
c. Identifyingresearchable problems , ,,,, ,,,,
d. Seeking funding to support research studies ,,,,,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
ANS: C ,,,, ,,,,
,Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,,
LATEST UPDATE 2022. ,,,, ,,,, ,,,,
When problems are identified, research can be properly conducted. Research of health care
,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,, ,
issues leads to evidence-based practice guidelines. Designing research studies is onlyone factor
,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,,, ,,,, ,
of the research process. Data collection is another factor of research. Financial support is
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necessaryto conduct research, but it is not the primary role of the nurse in the research process. , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,, , ,,, , ,, ,, ,,,, ,,,, ,,,,
DIF: Cognitive Level: Understand REF: im: 14 TOP: Nursing Process:
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N/AMSC: Client Needs: Safe and Effective Care Environment
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3. A 23-year-old African-American woman is pregnant with her first child. Based on the
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statistics for infant mortality, which plan is most important for the nurse to implement? ,,,, ,,,, ,,, ,,,, ,,,, ,,,, , ,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, ,
a. Perform a nutrition assessment. ,,,, ,,,, ,,,, ,,, ,,,, ,,,,
b. Refer the woman to a social worker. ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
c. Advise the woman to see an obstetrician, not a midwife. ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
d. Explain to the woman the importance of keeping her prenatal care appointments. ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
ANS: D ,,,, ,,,,
Consistent prenatal care is the best method of preventing or controlling risk factors associated ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,,
with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the
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most important action a nurse should take in this situation. The client mayneed assistance from a
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social worker at some time during her pregnancy, but a referral to a social worker is not the
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most important aspect the nurse should address at this time. If the woman has identifiable high-
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risk problems, then her health care may need to be provided by a physician. However, it
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cannot be assumed that all African-American women have high-risk issues. In addition,
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advising the woman to see an obstetrician is not the most important aspect on which the nurse
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should focus atthis time, and it is not appropriate for a nurse to advise or manage the type of
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care a client is to receive.
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DIF: Cognitive Level: Understand REF: IM: TOP: Nursing Process: Planning
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MSC: Client Needs: Health Promotion and Maintenance ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,
4. During a prenatal intake interview, the nurse is in the process of obtaining an initial ,,, , ,,,, ,,,, ,,,, ,, ,, ,,, , ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, , , ,, , ,,, ,,, , ,,,, ,,,, ,, ,, ,,, , ,, ,, ,,, , ,,,, ,,,, ,,,, ,, ,, , ,,, , ,,,
assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the ,,,, ,,,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,
most important for the nurse to perform?
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a. Use maternityjargon to enable the client to become familiar with these terms. ,,, ,, , ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
, Maternity & Women’s Health Care 12th Edition Lowdermilk Test Bank CHAPTER 1 TO 36 WELL EXPLAINED ANSWERS
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LATEST UPDATE 2022. ,,,, ,,,, ,,,,
b. Speak quickly and efficientlyto expedite the visit. ,,,, ,,,, ,,, ,, ,,,, ,,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
c. Provide the client with handouts. ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
d. Assess whether the client understands the discussion. ,,,, ,,,, ,,,, ,,, ,,,, ,, ,, ,, , ,,, ,,,, ,,,, ,,,, ,,,,
ANS: D ,,,, ,,,,
Nurses contribute to health literacy by using simple, common words, avoiding jargon, and
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evaluating whether the client understands the discussion. Speaking slowly and clearly and ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,, ,, ,,, ,
focusing on what is important will increase understanding. Most client education materials are
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written at a level too high for the average adult and may not be useful for a client with
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limitedEnglish proficiency. , ,, ,, ,,,,
DIF: Cognitive Level: ApplyREF: im: 5 TOP: Nursing Process: Evaluation
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MSC: Client Needs: Health Promotion and Maintenance
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5. The nurses working at a newly established birthing center have begun to compare their
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performance in providing maternal-newborn care against clinical standards. This comparison ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,,,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,
process is most commonly known as what? ,,,, ,,, ,,,, ,,,, ,,,, ,,,, ,,,,,,,, , ,,, ,, ,, ,,,, ,,,,
a. Best practices network ,,,,, ,,,, ,,,,
b. Clinical benchmarking ,,,,,
c. Outcomes-oriented practice ,,,,,,
d. Evidence-based practice ,,,, ,,,, ,
ANS: C ,,,, ,,,,
Outcomes-oriented practice measures the effectiveness of the interventions and quality of care ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, , ,,, ,,,, ,, ,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,, , ,,,, ,,,, ,,,, ,,,, ,,,, ,, ,, ,,, ,
against benchmarks or standards. The term best practice refers to a program or service that has
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been recognized for its excellence. Clinical benchmarking is a process used to compare ones
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ownperformance against the performance of the best in an area of service. The term evidence-
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based practice refers to the provision of care based on evidence gained through research and
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clinical trials. , ,,, ,, ,,
DIF: Cognitive Level: Understand REF: im: 11 TOP: Nursing Process:
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EvaluationMSC: Client Needs: Safe and Effective Care Environment , ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,, ,,,,
