lOMoARcPSD| 12263423
Test bank for High Acuity Nursing 7th Edition Wagner
g g g g g g g gg
Pierce Welsh -latest-2023-2024
g g g
Chapterg1.gHigh-
AcuitygNursinggQuestiong1
Type:gMCSA
Thegpatientgwhoghadgsurgerygyesterdaygreportsghisgchestgfeelsgtight.gAssessmentgrevealsgrespiratory
grategofg29,ginspiratorygwheezes,gstridor,gandgangoxygenationgsaturationgofg80%.gThegnursegwouldgco
nsidergthisgpatientgtogbegwhichgprioritygforgtransfergtogthegintensivegcaregunitg(ICU)?
1. Priorityg1
2. Priorityg2
3. Priorityg3
4. Priorityg4
CorrectgAnswer:g1
Rationaleg1:gThisgpatientgisgexhibitinggsignsgofgangacutegrespiratorygeventgforgwhichgintubationgorgo
thergintensivegtreatmentgmaygbegnecessary.gPriorityg1gpatientsgaregacutelygillgandgneedgintensivegtre
atmentgandgmonitoringgnotgprovidedgoutsidegofgthegICU.
Rationaleg2:gPriorityg2grefersgtogpatientsgneedinggintensivegmonitoringgandgmaygpotentiallygneedgad
ditionalginterventions.gTheygaregtypicallygnotgevolvinggangacutegeventgasgisgthegcasegwithgthisgpatien
t.
Rationaleg3:gPriorityg3gpatientsgaregcriticallygillgbutghaveglittlegchancegofgrecoverygfromgtheirgillness
es.gLimitsgaregplacedgongtherapeuticginterventionsgandgtheygcangbegcaredgforgingareasgothergthangthegI
CUgifgnecessary.
Rationaleg4:gPriorityg4gpatientsghavegnogsignsgorgsymptomsgthatgindicategintensivegmonitoringgorgtre
atmentgaregnecessary.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gPlanninggLearni
nggOutcome:g1-1
Questiong2gType
:gMCSA
Thegdaughtergofgagpatientgwhogisgdyinggquestionsgthegplacementgofghergfathergongthegmedicalsurgica
lgcaregunitg(MSCU).gShegrequestsghegbegplacedgingthegintensivegcaregunitg(ICU)gbecausegofgconcerng
hergfathergmaygnotgreceivegclosegobservationgongagbusyghospitalgunit.gWhichgactiongisgindicatedgbygt
hegnurse?
1. Notifygthegintensivegcaregunitgofgangimpendinggtransfer.
2. TellgthegdaughtergthatghergfathergdoesgnotgmeetgcriteriagforgplacementgingthegmoregexpensivegI
CU.
3. Discussgthegcaregthatgcangbegprovidedgongthegunitgwithgthegfamilygmember.
4. Contactgthegphysician.
CorrectgAnswer:g3
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Rationaleg1:gThegnursegcannotgmakegthisgtransfergdecisiongindependently.
Rationaleg2:gTellinggthegdaughtergthatghergfathergdoesgnotgmeetgcriteriagforgtransfergisgnotgtherapeuti
c.gBringinggupgthegissuegofgcostgmaygcausegthegdaughtergtogoffergtogpaygthegdifferencegbetweengthegc
ostsgofgthegtwogunits.gThisgwouldgcreategagseriousgethicalgdilemma.
Rationaleg3:gThegbestginitialgresponsegisgtoghelpgthegdaughtergunderstandgtheglevelgofgcaregandgobser
vationgthatgwillgbegprovidedgongthegMSCUgsogasgtoghelpghergunderstandgthatghergfathersgcaregwillgbeg
agpriority.
Rationaleg4:gThegnursegshouldgtrygtogintervenegingthisgsituationgbeforeginvolvinggthegphysician.gGlob
algRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementationg
LearninggOutcome:g1-1
Questiong3gType
:gMCSA
Agnursegwhogisgcontemplatinggtakinggagpositiongingangintensivegcaregunitgisgreviewingghergstrengthsg
andgweaknesses.gWhichgcharacteristicsgofgthegnursegwillgbegofgtheggreatestgbenefitgingthegintensivegc
aregenvironment?
1. Feelsgcomfortablegingevergchanginggsituations
2. Closelygevaluatesgthegprosgandgconsgofgeachgdecisiongforgaglonggperiodgofgtimegbeforegmakinggagd
ecision
3. Isgquietgandgintroverted
4. Isgexcitedgaboutgallgnewgexperiencesg
CorrectgAnswer:g1
Rationaleg1:gThegnursegingthegintensivegcaregunitgmustgbegopengtogever-
changinggsituations.gThegnursegmustgbegflexible.
Rationaleg2:gThegrapidgchangesgingthegintensivegcaregunitgdognotgallowgforgextendedgtimegwhengcons
ideringgactions.
Rationaleg3:gAgquietgandgintrovertedgnursegmaygnotgbegaggoodgmatchgforgtheghighgpacedghigh-
gacuitygcaregunitgduegtogthegneedgforgteamworkgandginteraction.
Rationaleg4:gExcitementgaboutgallgexperiencesgisgagbeneficialgcharacteristicginghealthcaregbutgisgnot
gthegmostgimportantgfactorgforgthisgparticulargcaregunit.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gAssessmentg
LearninggOutcome:g1-2
Questiong4gType
:gMCSA
Thegregisteredgnursegisgworkinggasgchargegnursegongagbusyghigh-
acuitygcaregunit.gUnexpectedly,gagcoworkergbecomesgillgandgneedsgtogleave.gTheregisgagperiodgofgtim
egingwhichgthegunitgisgshort
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staffedgwhilegthegillgcoworkersgreplacementgtravelsgingtogwork.gWhatgactiongbygthegchargegnursegisgindicated?
1. Makegnogchangesguntilgthegreplacementgnursegarrives.
2. Assigngtheglessgacutegpatientsgtogbegcaredgforgbygthegunlicensedgassistivegpersonnel.
3. Assigngthegunlicensedgassistivegpersonnelgtogwatchgthegmonitorsgandgcallgforghelpgifgagpatientgg
etsgintogtrouble.
4. Contactgtheghousegsupervisorgandgaskgforgagfloatgnursegtogbegsentgtogthegunit.g
CorrectgAnswer:g4
Rationaleg1:gThegunitgisgunderstaffed.gReplacementghelpgmustgbegprovided.gItgisginappropriategtogwa
itgforgthegreplacementgnurse.
Rationaleg2:gThegunlicensedgassistivegpersonnelgaregonlygablegtogprovidegcaregundergthegdirectgsuper
visiongofgthegnurse.
Rationaleg3:gWatchinggmonitorsgisgnotgwithingthegjobgdescriptiongofgthegunlicensedgassistivegp
ersonnelgandgisgnotgappropriate.gThegmanagergwouldgbegputtinggbothgpatientgsafetygandgthegun
licensedgassistivegpersonnelgatgrisk.
Rationaleg4:gThegmanagergshouldgobtainghelpguntilgthegreplacementgnursegarrives.gContactinggthegho
usegsupervisorgandgaskinggforgagtemporarygfloatgnursegisgthegbestgintervention.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementationg
LearninggOutcome:g1-2
Questiong5gType
:gMCSA
Agrecentgnursinggschoolggraduategreportsghavingganginterviewgwithgagmagnetghospital.gWhengprepa
ringgforgtheginterview,gtheggraduategnursegresearchesgthegconceptgofgmagnetgstatus.gWhichgperceptio
nsgbygthegnursegindicategangadequategunderstanding?
1. MagnetgstatusgisgangaccreditationgfromgthegNationalgLeaguegforgNurses.
2. Magnetgstatusgfacilitiesgpaygsubstantialgrecruitmentgbonuses.
3. Magnetgstatusgfacilitiesgpromotegtheginterestsgofgprofessionalgnursing.
4. Magnetgstatusghospitalsgmustgestablishgnurse-to-
patientgratios.gCorrectgAnswer:g3
Rationaleg1:gMagnetgstatusgisgagdesignationgdevelopedgbygthegAmericangNursesgCredentialinggCent
er.
Rationaleg2:gFacilitiesgwithgmagnetgdesignationgattractgnursesgbecausegofgtheirgworkgenvironment.g
Oftengtheregisgnogneedgtogpaygrecruitmentgbonuses.
Rationaleg3:gMagnetgstatusgisgawardedgtoghospitalsgthatgaregablegtogprovegtheirgcommitmentgtogprofe
ssionalgnursinggpractices.
Rationaleg4:gNurse-to-
patientgratiosgaregnotgpartgofgthegmagnetghospitalgdesignation.gGlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironment
, ClientgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gEvaluationgLear
ninggOutcome:g1-2
Questiong6gType
:gMCSA
Agteamgofgnursesgwouldglikegtogresearchgoutcomesgofgintensivegcaregthatgexpandgbeyondgthosegthatga
regnormallygstudied.gThisgteamgwouldgrecognizegwhichgoutcomegasgmostgcommonlygstudied?
1. Patientgcomfort
2. Patientgperceivedgqualitygofglife
3. Functionalgstatus
4. Mortality
CorrectgAnswer:g4
Rationaleg1:gPatientgcomfortgisgagverygimportantgoutcome,gbutgisgnotgthegonegmostgcommonlygstudie
d.
Rationaleg2:gQualitygofglifegaftergintensivegcaregisgagverygimportantgoutcome,gbutgisgnotgthegonegmost
gcommonlygstudied.
Rationaleg3:gFunctionalgstatusgaftergtreatmentgingthegintensivegcaregunitgisgagverygimportantgoutcome
,gbutgisgnotgthegonegmostgcommonlygstudied.
Rationaleg4:gMortalitygisgthegmostgcommonlygstudiedgoutcomegofgintensivegcaregtreatment.gGlobalg
Rationale:
CognitivegLevel:gApplying
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gAssessmentg
LearninggOutcome:g1-2
Questiong7gType
:gMCSA
Agnewlygemployedgnursegisgworkinggwithgangexperiencedgregisteredgnurse.gDuringgthegshift,gthegex
periencedgnursegroutinelygusesghergpersonalgdigitalgassistant.gHowgwouldgthegnursegexplaingtheguseg
ofgthisgdevicegtogthegnovicegnurse?
1. IgusegmygPDAgasgagreferencegtoolgseveralgtimesgeverygday.
2. IgcangaccessgmygpatientsgoldgmedicalgrecordsgongthisgPDA.
3. IgusegmygPDAgtogletgthegpharmacygknowgwhengIgneedgmedications.
4. IgusegmygPDAgtogwritegnursinggnotes.g
CorrectgAnswer:g1
Rationaleg1:gThegpersonalgdigitalgassistantg(PDA)gisgusedgtogprovidegquickgbedsideginformationgtogt
hegnurse.
Rationaleg2:gThegpatientsgpersonalgmedicalgrecordsgwouldgnotgbegaccessiblegthroughgthegPDA.gRati
onaleg3:gThegPDAgwouldgnotgbegusefulgforgthisgapplication.
Rationaleg4:gThegnursegshouldgnotgrecordgnursinggnotesgongthegPDA.gGlob
algRationale:
CognitivegLevel:gApplying
ClientgNeed:gSafegEffectivegCaregEnvironment
Test bank for High Acuity Nursing 7th Edition Wagner
g g g g g g g gg
Pierce Welsh -latest-2023-2024
g g g
Chapterg1.gHigh-
AcuitygNursinggQuestiong1
Type:gMCSA
Thegpatientgwhoghadgsurgerygyesterdaygreportsghisgchestgfeelsgtight.gAssessmentgrevealsgrespiratory
grategofg29,ginspiratorygwheezes,gstridor,gandgangoxygenationgsaturationgofg80%.gThegnursegwouldgco
nsidergthisgpatientgtogbegwhichgprioritygforgtransfergtogthegintensivegcaregunitg(ICU)?
1. Priorityg1
2. Priorityg2
3. Priorityg3
4. Priorityg4
CorrectgAnswer:g1
Rationaleg1:gThisgpatientgisgexhibitinggsignsgofgangacutegrespiratorygeventgforgwhichgintubationgorgo
thergintensivegtreatmentgmaygbegnecessary.gPriorityg1gpatientsgaregacutelygillgandgneedgintensivegtre
atmentgandgmonitoringgnotgprovidedgoutsidegofgthegICU.
Rationaleg2:gPriorityg2grefersgtogpatientsgneedinggintensivegmonitoringgandgmaygpotentiallygneedgad
ditionalginterventions.gTheygaregtypicallygnotgevolvinggangacutegeventgasgisgthegcasegwithgthisgpatien
t.
Rationaleg3:gPriorityg3gpatientsgaregcriticallygillgbutghaveglittlegchancegofgrecoverygfromgtheirgillness
es.gLimitsgaregplacedgongtherapeuticginterventionsgandgtheygcangbegcaredgforgingareasgothergthangthegI
CUgifgnecessary.
Rationaleg4:gPriorityg4gpatientsghavegnogsignsgorgsymptomsgthatgindicategintensivegmonitoringgorgtre
atmentgaregnecessary.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gPlanninggLearni
nggOutcome:g1-1
Questiong2gType
:gMCSA
Thegdaughtergofgagpatientgwhogisgdyinggquestionsgthegplacementgofghergfathergongthegmedicalsurgica
lgcaregunitg(MSCU).gShegrequestsghegbegplacedgingthegintensivegcaregunitg(ICU)gbecausegofgconcerng
hergfathergmaygnotgreceivegclosegobservationgongagbusyghospitalgunit.gWhichgactiongisgindicatedgbygt
hegnurse?
1. Notifygthegintensivegcaregunitgofgangimpendinggtransfer.
2. TellgthegdaughtergthatghergfathergdoesgnotgmeetgcriteriagforgplacementgingthegmoregexpensivegI
CU.
3. Discussgthegcaregthatgcangbegprovidedgongthegunitgwithgthegfamilygmember.
4. Contactgthegphysician.
CorrectgAnswer:g3
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Rationaleg1:gThegnursegcannotgmakegthisgtransfergdecisiongindependently.
Rationaleg2:gTellinggthegdaughtergthatghergfathergdoesgnotgmeetgcriteriagforgtransfergisgnotgtherapeuti
c.gBringinggupgthegissuegofgcostgmaygcausegthegdaughtergtogoffergtogpaygthegdifferencegbetweengthegc
ostsgofgthegtwogunits.gThisgwouldgcreategagseriousgethicalgdilemma.
Rationaleg3:gThegbestginitialgresponsegisgtoghelpgthegdaughtergunderstandgtheglevelgofgcaregandgobser
vationgthatgwillgbegprovidedgongthegMSCUgsogasgtoghelpghergunderstandgthatghergfathersgcaregwillgbeg
agpriority.
Rationaleg4:gThegnursegshouldgtrygtogintervenegingthisgsituationgbeforeginvolvinggthegphysician.gGlob
algRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementationg
LearninggOutcome:g1-1
Questiong3gType
:gMCSA
Agnursegwhogisgcontemplatinggtakinggagpositiongingangintensivegcaregunitgisgreviewingghergstrengthsg
andgweaknesses.gWhichgcharacteristicsgofgthegnursegwillgbegofgtheggreatestgbenefitgingthegintensivegc
aregenvironment?
1. Feelsgcomfortablegingevergchanginggsituations
2. Closelygevaluatesgthegprosgandgconsgofgeachgdecisiongforgaglonggperiodgofgtimegbeforegmakinggagd
ecision
3. Isgquietgandgintroverted
4. Isgexcitedgaboutgallgnewgexperiencesg
CorrectgAnswer:g1
Rationaleg1:gThegnursegingthegintensivegcaregunitgmustgbegopengtogever-
changinggsituations.gThegnursegmustgbegflexible.
Rationaleg2:gThegrapidgchangesgingthegintensivegcaregunitgdognotgallowgforgextendedgtimegwhengcons
ideringgactions.
Rationaleg3:gAgquietgandgintrovertedgnursegmaygnotgbegaggoodgmatchgforgtheghighgpacedghigh-
gacuitygcaregunitgduegtogthegneedgforgteamworkgandginteraction.
Rationaleg4:gExcitementgaboutgallgexperiencesgisgagbeneficialgcharacteristicginghealthcaregbutgisgnot
gthegmostgimportantgfactorgforgthisgparticulargcaregunit.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gAssessmentg
LearninggOutcome:g1-2
Questiong4gType
:gMCSA
Thegregisteredgnursegisgworkinggasgchargegnursegongagbusyghigh-
acuitygcaregunit.gUnexpectedly,gagcoworkergbecomesgillgandgneedsgtogleave.gTheregisgagperiodgofgtim
egingwhichgthegunitgisgshort
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staffedgwhilegthegillgcoworkersgreplacementgtravelsgingtogwork.gWhatgactiongbygthegchargegnursegisgindicated?
1. Makegnogchangesguntilgthegreplacementgnursegarrives.
2. Assigngtheglessgacutegpatientsgtogbegcaredgforgbygthegunlicensedgassistivegpersonnel.
3. Assigngthegunlicensedgassistivegpersonnelgtogwatchgthegmonitorsgandgcallgforghelpgifgagpatientgg
etsgintogtrouble.
4. Contactgtheghousegsupervisorgandgaskgforgagfloatgnursegtogbegsentgtogthegunit.g
CorrectgAnswer:g4
Rationaleg1:gThegunitgisgunderstaffed.gReplacementghelpgmustgbegprovided.gItgisginappropriategtogwa
itgforgthegreplacementgnurse.
Rationaleg2:gThegunlicensedgassistivegpersonnelgaregonlygablegtogprovidegcaregundergthegdirectgsuper
visiongofgthegnurse.
Rationaleg3:gWatchinggmonitorsgisgnotgwithingthegjobgdescriptiongofgthegunlicensedgassistivegp
ersonnelgandgisgnotgappropriate.gThegmanagergwouldgbegputtinggbothgpatientgsafetygandgthegun
licensedgassistivegpersonnelgatgrisk.
Rationaleg4:gThegmanagergshouldgobtainghelpguntilgthegreplacementgnursegarrives.gContactinggthegho
usegsupervisorgandgaskinggforgagtemporarygfloatgnursegisgthegbestgintervention.
GlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gImplementationg
LearninggOutcome:g1-2
Questiong5gType
:gMCSA
Agrecentgnursinggschoolggraduategreportsghavingganginterviewgwithgagmagnetghospital.gWhengprepa
ringgforgtheginterview,gtheggraduategnursegresearchesgthegconceptgofgmagnetgstatus.gWhichgperceptio
nsgbygthegnursegindicategangadequategunderstanding?
1. MagnetgstatusgisgangaccreditationgfromgthegNationalgLeaguegforgNurses.
2. Magnetgstatusgfacilitiesgpaygsubstantialgrecruitmentgbonuses.
3. Magnetgstatusgfacilitiesgpromotegtheginterestsgofgprofessionalgnursing.
4. Magnetgstatusghospitalsgmustgestablishgnurse-to-
patientgratios.gCorrectgAnswer:g3
Rationaleg1:gMagnetgstatusgisgagdesignationgdevelopedgbygthegAmericangNursesgCredentialinggCent
er.
Rationaleg2:gFacilitiesgwithgmagnetgdesignationgattractgnursesgbecausegofgtheirgworkgenvironment.g
Oftengtheregisgnogneedgtogpaygrecruitmentgbonuses.
Rationaleg3:gMagnetgstatusgisgawardedgtoghospitalsgthatgaregablegtogprovegtheirgcommitmentgtogprofe
ssionalgnursinggpractices.
Rationaleg4:gNurse-to-
patientgratiosgaregnotgpartgofgthegmagnetghospitalgdesignation.gGlobalgRationale:
CognitivegLevel:gAnalyzing
ClientgNeed:gSafegEffectivegCaregEnvironment
, ClientgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gEvaluationgLear
ninggOutcome:g1-2
Questiong6gType
:gMCSA
Agteamgofgnursesgwouldglikegtogresearchgoutcomesgofgintensivegcaregthatgexpandgbeyondgthosegthatga
regnormallygstudied.gThisgteamgwouldgrecognizegwhichgoutcomegasgmostgcommonlygstudied?
1. Patientgcomfort
2. Patientgperceivedgqualitygofglife
3. Functionalgstatus
4. Mortality
CorrectgAnswer:g4
Rationaleg1:gPatientgcomfortgisgagverygimportantgoutcome,gbutgisgnotgthegonegmostgcommonlygstudie
d.
Rationaleg2:gQualitygofglifegaftergintensivegcaregisgagverygimportantgoutcome,gbutgisgnotgthegonegmost
gcommonlygstudied.
Rationaleg3:gFunctionalgstatusgaftergtreatmentgingthegintensivegcaregunitgisgagverygimportantgoutcome
,gbutgisgnotgthegonegmostgcommonlygstudied.
Rationaleg4:gMortalitygisgthegmostgcommonlygstudiedgoutcomegofgintensivegcaregtreatment.gGlobalg
Rationale:
CognitivegLevel:gApplying
ClientgNeed:gSafegEffectivegCaregEnvironmentgClie
ntgNeedgSub:gManagementgofgCare
Nursing/IntegratedgConcepts:gNursinggProcess:gAssessmentg
LearninggOutcome:g1-2
Questiong7gType
:gMCSA
Agnewlygemployedgnursegisgworkinggwithgangexperiencedgregisteredgnurse.gDuringgthegshift,gthegex
periencedgnursegroutinelygusesghergpersonalgdigitalgassistant.gHowgwouldgthegnursegexplaingtheguseg
ofgthisgdevicegtogthegnovicegnurse?
1. IgusegmygPDAgasgagreferencegtoolgseveralgtimesgeverygday.
2. IgcangaccessgmygpatientsgoldgmedicalgrecordsgongthisgPDA.
3. IgusegmygPDAgtogletgthegpharmacygknowgwhengIgneedgmedications.
4. IgusegmygPDAgtogwritegnursinggnotes.g
CorrectgAnswer:g1
Rationaleg1:gThegpersonalgdigitalgassistantg(PDA)gisgusedgtogprovidegquickgbedsideginformationgtogt
hegnurse.
Rationaleg2:gThegpatientsgpersonalgmedicalgrecordsgwouldgnotgbegaccessiblegthroughgthegPDA.gRati
onaleg3:gThegPDAgwouldgnotgbegusefulgforgthisgapplication.
Rationaleg4:gThegnursegshouldgnotgrecordgnursinggnotesgongthegPDA.gGlob
algRationale:
CognitivegLevel:gApplying
ClientgNeed:gSafegEffectivegCaregEnvironment
