Sie sind auf Seite 1von 7

1. A client with a diagnosis of depression who has attempted suicide c.

c. Attempt to persuade the client to stay “for only a few


says to the nurse, “I should have died. I’ve always been a failure. more days.”
Nothing ever goes right for me.” Which response by the nurse d. Tell the client that leaving would likely result in an
demonstrates therapeutic communication? involuntary commitment.
a. “You have everything to live for.”
b. “Why do you see yourself as a failure? 8. When reviewing the admission assessment, the nurse notes that a
c. “Feeling like this is all part of being depressed.” client was admitted to the mental health unit involuntarily. Based on
d. “You’ve been feeling like a failure for a while?” this type of admission, the nurse should provide which intervention
for this client?
2. The nurse visits a client at home. The client states, “I haven’t slept a. Monitor closely for harm to self or others.
at all the last couple of ni ghts.” Which response by the nurse b. Assist in completing an application for admission.
demonstrates therapeutic communication? c. Supply the client with written information about his or her
a. “I see.” mental illness.
b. “Really?” d. Provide an opportunity for the family to discuss why they
c. “You’re having difficulty sleeping?” felt the admission was needed.
d. “Sometimes I have trouble sleeping too.”
9. When a client is admitted to an inpatient mental health unit with the
3. A client experiencing disturbed thought processes believes that his diagnosis of anorexia nervosa, a cognitive behavioral approach is
food is being poisoned. Which communication technique should the used as part of the treatment plan. The nurse plans care based on
nurse use to encourage the client to eat? which purpose of this approach?
a. Using open-ended questions and silence a. Providing a supportive environment
b. Sharing personal preference regarding food choices b. Examining intrapsychic conflicts and past issues
c. Documenting reasons why the client does not want to eat c. Emphasizing social interaction with clients who withdraw
d. Offering opinions about the necessity of adequate d. Helping the client to examine dysfunctional thoughts and
nutrition beliefs

4. The nurse should plan which goals of the termination stage of group 10. A client is preparing to attend a Gamblers Anonymous meeting for
development? Select all that apply. the first time. The nurse should tell the client that which is the first
a. The group evaluates the experience. step in this 12-step program?
b. The real work of the group is accomplished. a. Admitting to having a problem
c. Group interaction involves superficial conversation. b. Substituting other activities for gambling
d. Group members become acquainted with one another. c. Stating that the gambling will be stopped
e. Some structuring of group norms, roles, and d. Discontinuing relationships with people who gamble
responsibilities takes place.
f. The group explores members’ feelings about
g. the group and the impending separation. 11. The nurse employed in a mental health clinic is greeted by a neighbor
in a local grocery store. The neighbor says to the nurse, “How is Carol
5. A client diagnosed with terminal cancer says to the nurse, “I’m going doing? She is my best friend and is seen at your clinic every week.”
to die, and I wish my family would stop hoping for a cure! I get so Which is the most appropriate nursing response?
angry when they carry on like this. After all, I’m the one who’s dying. a. “I cannot discuss any client situation with you.”
“Which response by the nurse is therapeutic? b. “If you want to know about Carol, you need to ask her
a. “Have you shared your feelings with your family?” yourself.”
b. “I think we should talk more about your anger with your c. “Only because you’re worried about a friend, I’ll tell you
family.” that she is improving.”
c. “You’re feeling angry that your family continues to hope d. “Being her friend, you know she is having a difficult time
for you to be cured?” and deserves her privacy.”
d. “You are probably very depressed, which is
understandable with such a diagnosis.” 12. The nurse calls security and has physical restraints applied to a
client who was admitted voluntarily when the client becomes
verbally abusive, demanding to be discharged from the hospital.
6. On review of the client’s record, the nurse notes that the admission Which represents the possible legal ramifications for the nurse
was voluntary. Based on this information, the nurse plans care associated with these interventions? Select all that apply.
anticipating which client behavior? a. Libel
a. Fearfulness regarding treatment measures b. Battery
b. Anger and aggressiveness directed toward othe rs c. Assault
c. An understanding of the pathology and symptoms of the d. Slander
diagnosis e. False imprisonment
d. A willingness to participate in the planning of the care and
treatment plan 13. The nurse in the mental health unit plans to use which therapeutic
communication techniques when communicating with a client? Select
7. A client admitted voluntarily for treatment of an anxiety disorder all that apply.
demands to be released from the hospital. Whi ch action should the a. Restating
nurse take initially? b. Listening
a. Contact the client’s health care provider (HCP). c. Asking the client “Why?”
b. Call the client’s family to arrange for transportation. d. Maintaining neutral responses
e. Providing acknowledgment and feedback a. Encouraging quiet reading and writing for the first few
f. Giving advice and approval or disapproval days
b. Identification of physical activities that will provide
14. What is the most appropriate nursing ac tion to help manage a manic exercise
client who is monopolizing a group therapy session? c. No socializing activities, until the client asks to
a. Ask the client to leave the group for this session only. participate in milieu
b. Refer the client to another group that includes other d. A structured program of activities in which the client ca n
manic clients. participate
c. Tell the client to stop monopolizing in a firm but
compassionate manner. 21. When planning the discharge of a client with chronic anxiety, the
d. Thank the client for the input, but inform the client that nurse directs the goals at promoting a safe environment at home.
others now need a chance to contribute. Which is the most appropriate maintenance goal?
a. Suppressing feelings of anxiety
15. A client is participating in a therapy group and focuses on viewing b. Identifying anxiety-producing situations
all team members as equally important in helping the clients to c. Continuing contact with a crisis counselor
meet their goals. The nurse is implementing which therapeutic d. Eliminating all anxiety from daily situations
approach?
a. Milieu therapy 22. A client is unwilling to go to his church because his ex -girlfriend goes
b. Interpersonal therapy there and he feels that she will laugh at him if she sees him. Because
c. Behavior modification of this hypersensitivity to a reaction from her, the client remains
d. Support group therapy homebound. The home care nurse develops a plan of care that
addresses which personality disorder?
16. The nurse is working with a client who despite making a heroic effort a. Avoidant
was unable to rescue a neighbor trapped in a house fire. Which client b. Borderline
focused action should the nurse engage in during the working phase c. Schizotypal
of the nurse-client relationship? d. Obsessive-compulsive
a. Exploring the client’s ability to function
b. Exploring the client’s potential for self -harm 23. The nurse is conducting a group therapy session . During the session,
c. Inquiring about the client’s perception or appraisal of why a client diagnosed with mania consistently disrupts the group’s
the rescue was unsuccessful interactions. Which intervention should the nurse initially
d. Inquiring about and examining the client’s feelings for any implement?
that may block adaptive coping a. Setting limits on the client’s behavior
b. Asking the client to leave the group session
17. The nurse provides an educational session on client rights. Which c. Asking another nurse to escort the client out of the group
statement by a member of the session demonstrates the best session
understanding of the nurse’s role regarding ensuring that each d. Telling the client that they will not be able to attend any
client’s rights are respected? future group sessions
a. “Autonomy is the fundamental right of each and every
client.” 24. A client is admitted to a medical nursing unit with a diagnosis of
b. “A client’s rights are guaranteed by both state and federal acute blindness after being involved in a hit -and-run accident. When
laws.” diagnostic testing cannot identify any organic reason why this client
c. “Being respectful and concerned will ensure that I’m cannot see, a mental health consult is prescribed. The nurse plans
attentive to my clients’ rights.” care based on which condition that should be the focus of this
d. “Regardless of the client’s condition, all nurses have the consult?
duty to value client rights.” a. Psychosis
b. Repression
18. A client says to the nurse, “The federal guards were sent to kill me.” c. Conversion disorder
Which is the best response by the nurse to the client’s concern? d. Dissociative disorder
a. “I don’t believe this is true.”
b. “The guards are not out to kill you.” 25. A manic client begins to make sexual advances toward visitors in the
c. “Do you feel afraid that people are trying to hurt you?” dayroom. When the nurse firmly states that this is inappropriate and
d. “What makes you think the guards were sent to hurt you?” will not be allowed, the client becomes verbally abusive and
threatens physical violence to the nurse. Based on the analysis of
19. A client diagno sed with delirium becomes disoriented and confused this situation, which intervention should the nurse implement?
at night. Which intervention should the nurse implement initially? a. Place the client in seclusion for 30 minutes.
a. Move the client next to the nurses’ station. b. Tell the client that the behavior is inappropriate.
b. Use an indirect light source and turn off the television. c. Escort the client to their room, with the assis tance of
c. Keep the television and a soft ligh t on during the night. other staff.
d. Play soft music during the night and maintain a well -lit d. Tell the client that their telephone privileges are revoked
room. for 24 hours.

20. A client is admitted to the mental health unit with a diagnosis of 26. Which nursing interventions are appropriate for a hospitalized client
depression. The nurse should develop a plan of care for the client with mania who is exhibiting manipulative behavior? Select all that
that includes which intervention? apply.
a. Communicate expected behaviors to the client.
b. Ensure that the client knows that they are not in charge 32. The home health nurse visits a client at home and determines that
of the nursing unit. the client is dependent on drugs. During the assessment, which
c. Assist the client in identifying ways of setting limits on action should the nurse take to plan appropriate nursing care?
personal behaviors. a. Ask the client why he started taking illegal drugs.
d. Follow through about the consequences of behavior in a b. Ask the client about the amount of drug use and its effect.
nonpunitive manner. c. Ask the client how long he thought that he could take
e. Enforce rules by informing the client that he/she will not drugs without someone finding out.
be allowed to attend therapy groups. d. Not ask any questions for fear that the client is in denial
f. Have the client state the consequences for behaving in and will throw the nurse out of the home.
ways that are viewed as unacceptable.
33. Which interventions are most appropriate for caring for a client in
27. The nurse observes that a client is pacing, agitated, and presenting alcohol withdrawal? Select all that apply.
aggressive gestures. The client’s speech pattern is rapid, and affect a. Monitor vital signs.
is belligerent. Based on these observations, which s the nurse’s b. Provide a safe environment.
immediate priority of care? c. Address hallucinations therapeutically.
a. Provide safety for the client and other clients on the unit. d. Provide stimulation in the environment.
b. Provide the clients o n the unit with a sense of comfort and e. Provide reality orientation as appropriate.
safety. f. Maintain NPO (nothing by mouth) status.
c. Assist the staff in caring for the client in a controlled
environment. 34. The nurse determines that the wife of an alcoholic client is
d. Offer the client a less stimulating area in which to calm benefiting from attending an Al -Anon group if the nurse hears the
down and gain control. wife make which statement?
a. “I no longer feel that I deserve the beatings my husband
28. The nurse is preparing a client with a history of command inflicts on me.”
hallucinations for discharge by providing instructions on b. “My attendance at the meetings has helped me to see that
interventions for managing hallucinations and anxiety. Which I provoke my husband’s violence.”
statement in response to these instructions suggests to the nurse c. “I enjoy attending the meetings because they get me out
that the client has a need for additional information? of the house and away from my husband.”
a. “My medications will help my anxious feelings.” d. “I can tolerate my husband’s destructive behaviors now
b. “I’ll go to support group and talk about what I am feeling.” that I know they are common among alcoholics.”
c. “I need to get enough sleep and eat well to help prevent
feeling anxious.” 35. A hospitalized client with a history of alcohol abuse tells the nurse,
d. “When I have command hallucinations, I’ll call a friend and “I am leaving now. I have to go. I don’t want any more treatment. I
ask him what I should do.” have things that I have to do right away.” The client has not been
discharged and is scheduled for an important diagn ostic test to be
29. The nurse is caring for a client just admitted to the mental health performed in 1 hour. After the nurse discusses the client’s concerns
unit and diagnosed with catatonic stupor. The client is lying on the with the client, the client dresses and begins to walk out of the
bed in a fetal position. Which is the most appropriate nursing hospital room. What action should the nurse take?
intervention? a. Call the nursing supervisor.
a. Ask direct questions to encourage talking. b. Call security to block al l exit areas.
b. Leave the client alone so as to minimize external stimuli. c. Restrain the client until the health care provider (HCP)
c. Sit beside the client in silence with occasional open -ended can be reached.
questions. d. Tell the client that the client cannot return to this
d. Take the client into the dayroom with other clients so that hospital again if the client leaves now.
they can help watch them.
36. The nurse is preparing to perform an admission assessment on a
30. The nurse is caring for a clie nt diagnosed with paranoid personality client with a diagnosis of bulimia nervosa. Which assessment
disorder who is experiencing disturbed thought processes. In findings should the nurse expect to note? Select all that apply.
formulating a nursing plan of care, which best intervention should a. Dental decay
the nurse include? b. Moist, oily skin
a. Increase socialization of the client with peers. c. Loss of tooth enamel
b. Avoid using a whisper voice in front of the client. d. Electrolyte imbalances
c. Begin to educate the client about social supports in the e. Body weight well below ideal range
community.
d. Have the client sign a release of information to 37. The nurse is caring for a female client who was admitted to the
appropriate parties for assessment purposes. mental health unit recently for anorexia nervosa. The nurse enters
the client’s room and notes that the client is engaged in rigorous
31. The nurse is planning activities for a client diagnosed with b ipolar push-ups. Which nursing action is most appropriate?
disorder with aggressive social behavior. Which activity would be a. Interrupt the client and weigh her immediately.
most appropriate for this client? b. Interrupt the client and offer to take her for a walk.
a. Chess c. Allow the client to complete her exercise program.
b. Writing d. Tell the client that she is not allowed to exercise
c. Ping pong rigorously.
d. Basketball
38. A client with a diagnosis of anorexia nervosa, who is in a state of c. “What leads you to seek help now?”
starvation, is in a 2-bed room. A newly admitted client will be d. “What do you usually do to feel better?”
assigned to this client’s room. Which client would be the best choice
as a roommate for the client with anorexia nervosa? 45. The nurse is creating a plan of care for a client in a crisis state. When
a. A client with pneumonia developing the plan, the nurse should consider which factor?
b. A client undergoing diagnostic tests a. A crisis state indicates that the client has a mental illness.
c. A client who thrives on managing others b. A crisis state indicates that the client has an emotional
d. A client who could benefit from the client’s assistance at illness.
mealtime c. Presenting symptoms in a crisis situation are similar for
all clients experiencing a crisis.
39. The nurse is monitoring a hospitalized client who abuses alcohol. d. A client’s response to a crisis is individualized and what
Which findings should alert the nurse to the potential for alcohol constitutes a crisis for one client may not constitute a
withdrawal delirium? crisis for another client.
a. Hypotension, ataxia, hunger
b. Stupor, lethargy, muscular rigidity 46. The nurse in the emergency department is caring for a young female
c. Hypotension, coarse hand tremors, lethargy victim of sexual assault. The client’s physical assessment is
d. Hypertension, changes in level of consciousness, complete, and physical evidence has been collected. The nurse notes
hallucinations that the client is withdrawn, confused, and at times physically
immobile. How should the nurse interpret these behaviors?
40. The spouse of a client admitted to the mental health unit for alcohol a. Signs of depression
withdrawal says to the nurse, “I should get out of this bad situation.” b. Reactions to a devastating event
Which is the most helpful response by the nurse? c. Evidence that the client is a h igh suicide risk
a. “Why don’t you tell your spouse about this?” d. Indicative of the need for hospital admission
b. “What do you find difficult about this situation?”
c. “This is not the best time to make that decision.” 47. A depressed client on an inpatient unit says to the nurse, “My family
d. “I agree with you. You should get out of this situation.” would be better off without me.” Which is the nurse’s best response?
a. “Have you talked to your family about this?”
41. A client with anorexia nervosa is a member of a pre-discharge b. “Everyone feels this way when they are depressed.”
support group. The client verbalizes that she would like to buy some c. “You will feel better once your medication begins to
new clothes, but her finances are limited. Group members have work.”
brought some used clothes to the client to replace the client’s old d. “You sound very upset. Are you thinking of hurting
clothes. The client believes that the new clothes are much too tight yourself?”
and has reduced her calorie intake to 800 calories daily. How should
the nurse evaluate this behavior? 48. The nurse has been closely observing a client who has been
a. Normal behavior displaying aggressive behaviors. The nurse observes that the
b. Evidence of the client’s disturbed body image behavior displayed by the client is escalating. Which nursing
c. Regression as the client is moving toward the community intervention is most helpful to this client at this time? Select all that
d. Indicative of the client’s ambivalence about hospital apply.
discharge a. Initiate confinement measures.
b. Acknowledge the client’s behavior.
42. The nurse observes that a client with a potential for violence is c. Assist the client to an area that is quiet.
agitated, pacing up and down the hallway, and is making aggressive d. Maintain a safe distance from the client.
and belligerent gestures at other clients. Which statement would be e. Allow the client to take control of the situation.
most appropriate to make to this client?
a. “You need to stop that behavior now.” 49. Which behavior observed by the nurse indicates a suspicion that a
b. “You will need to be placed in seclusion.” depressed adolescent client may be suicidal?
c. “You seem restless; tell me what is happening.” a. The adolescent gives away a DVD and a cherished
d. “You will need to be restrained if you do not change your autographed picture of a performer.
behavior.” b. The adolescent runs out of the therapy group, swearing at
the group leader, and to her room.
43. The nurse is reviewing the assessment data of a client admitted to c. The adolescent becomes angry while speaking on the
the mental health unit. The nurse notes that the admission nurse telephone and slams down the receiver.
documented that the client is experiencing anxiety as a result of a d. The adolescent gets angry with her roommate when the
situational crisis. The nurse plans care for the client, determining roommate borrows the client’s clothes without asking.
that this type of crisis could be caused by which event?
a. Witnessing a murder 50. The police arrive at the emergency department with a client who has
b. The death of a loved one lacerated both wrists. Which is the initial nursing action?
c. A fire that destroyed the client’s home a. Administer an antianxiety agent.
d. A recent rape episode experienced by the client b. Assess and treat the wound sites.
c. Secure and record a detailed history.
44. The nurse is conducting an initial assessment of a client in crisis. d. Encourage and assist the client to ventilate feelings.
When assessing the client’s perception of the precipitating event
that led to the crisis, which is the most appropriate question? 51. A moderately depressed client who was hospitalized 2 days ago
a. “With whom do you live ?” suddenly begins smiling and reporting that the crisis is over. The
b. “Who is available to help you?”
client says to the nurse, “I’m finally cured.” How should the nurse d. As needed when the client complains of depression
interpret this behavior as a cue to modify the treatment plan?
a. Suggesting a reduction of medication 58. A client with schizophrenia has been started on medication therapy
b. Allowing increased “in-room” activities with clozapine. The nurse should assess the results of which
c. Increasing the level of suicide precau tions laboratory study to monitor for adverse effects from this
d. Allowing the client off-unit privileges as needed medication?
a. Platelet count
52. The nurse is planning care for a client being admitted to the nursing b. Blood glucose level
unit who attempted suicide. Which priority nursing intervention c. Liver function studies
should the nurse include in the plan of care? d. White blood cell count
a. One-to-one suicide precautions
b. Suicide precautions with 30-minute checks 59. A client is scheduled for discharge and will be taking phenobarbital
c. Checking the whereabouts of the client every 15 minutes for an extended period. The nurse would place highest priority on
d. Asking the client to report suicidal thought immediately teaching the client which point that directly relates to client safety?
a. Take the medication only with meals.
53. The emergency department nurse is caring for an adult client who is b. Take the medication at the same time each day.
a victim of family violence. Which priority instruction should be c. Use a dose container to help prevent missed doses.
included in the discharge instructions? d. Avoid drinking alcohol while taking this medication.
a. Information regarding shelters
b. Instructions regarding calling the police 60. The nurse is describing the medi cation side and adverse effects to a
c. Instructions regarding self-defense classes client who is taking oxazepam. Which information should the nurse
d. Explaining the importance of leaving the violent situation incorporate in the discussion?
a. Consume a low-fiber diet.
54. A female victim of a sexual assault is being seen in the crisis center. b. Increase fluids and bulk in the diet.
The client states that she still feels “as though the rape just c. Rest if the heart begins to beat rapidly.
happened yesterday,” even though it has been a few months since d. Take antidiarrheal agents if diarrhea occurs.
the incident. Which is the most appropriate nurs ing response?
a. “You need to try to be realistic. The rape did not just 61. The nurse is administering risperidone to a client who is scheduled
occur.” to be discharged. Before discharge, which instruction should the
b. “It will take some time to get over these feelings about nurse provide to the client?
your rape.” a. Get adequate sunlight.
c. “Tell me more about the incident that causes you to feel b. Continue driving as usual.
like the rape just occurred.” c. Avoid foods rich in potassium.
d. “What do you think that you can do to alleviate some of d. Get up slowly when changing positions.
your fears about being raped again?”
62. The nurse is teaching a client who is being started on imipramine
55. A client is admitted to the mental health unit after an attempted about the medication. The nurse should inform the client to expect
suicide by hanging. The nurse can best ensure client safety by which maximum desired effects at which time period following initiatio n of
action? the medication?
a. Requesting that a peer remain with the client at all times a. In 2 months
b. Removing the client’s clothing and placing the client in a b. In 2 to 3 weeks
hospital gown c. During the first week
c. Assigning to the client a staff member who will remain d. During the sixth week of administration
with the client at all times
d. Admitting the client to a seclusion room where all 63. A hospitalized client is started on phenelzine for the treatment of
potentially dangerous articl es are removed depression. The nurse should instruct the client that which foods are
acceptable to consume while taking this medication? Select all that
56. A client is admitted with a recent history of severe anxiety following apply.
a home invasion and robbery. During the initial assessment a. Figs
interview, which statement by the client should indicate to the nurse b. Yogurt
the possible diagnosis of posttraumatic stress disorder? Select all c. Crackers
that apply. d. Aged cheese
a. “I’m afraid of spiders.” e. Tossed salad
b. “I keep reliving the robbery.” f. Oatmeal raisin cookies
c. “I see his face everywhere I go.”
d. “I don’t want anything to eat now.” 64. The nurse notes that a client with schizophrenia and receiving an
e. “I might have died over a few dollars in my pocket.” antipsychotic medication is moving her mouth, protruding her
f. “I have to wash my hands over and over again many times.” tongue, and grimacing as she watches television. The nurse
determines that the client is experiencing which medication
57. A client’s medication sheet contains a prescription for sertraline. To complication?
ensure safe administration of the medication, how should the nurse a. Parkinsonism
administer the dose? b. Tardive dyskinesia
a. On an empty stomach c. Hypertensive crisis
b. At the same time each evening d. Neuroleptic malignant syndrome
c. Evenly spaced around the clock
65. The nurse is performing a follow-up teaching session with a client
discharged 1 month ago. The client is taking fluoxetine. Which
information would be important for the nurse to obtain during this
client visit regarding the side and adverse effects of the medication?
a. Cardiovascular symptoms
b. Gastrointestinal dysfunctions
c. Problems with mouth dryness
d. Problems with excessive sweating

66. A client who has been taking buspirone for 1 month returns to the
clinic for a follow-up assessment. The nurse determines that the
medication is effective if the absence of which manifestation has
occurred?
a. Paranoid thought process
b. Rapid heartbeat or anxiety
c. Alcohol withdrawal symptoms
d. Thought broadcasting or delusions

67. A client taking lithium reports vomiting, abdominal pain, diarrhea,


blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L
(2.5 mmol/L). The nurse plans care based on which representation of
this level?
a. Toxic
b. Normal
c. Slightly above normal
d. Excessively below normal

68. A client gives the home health nurse a bottle of clomipramine. The
nurse notes that the medication has not been taken by the client in
2 months. Which behavior observed in the client would validate
noncompliance with this medication?
a. Complaints of insomnia
b. Complaints of hunger and fatigue
c. A pulse rate less than 60 beats/minute
d. Frequent hand washing with hot, soapy water

69. A hospitalized client has begun taking bupropion as an


antidepressant agent. The nurse determines that which is an adverse
effect, indicating that the client is taking an excessive amount of
medication?
a. Constipation
b. Seizure activity
c. Increased weight
d. Dizziness when getting upright

70. A client receiving tricyclic antidepressants arrives at the mental


health clinic. Which observation would indicate that the client is
following the medication plan correctly?
a. Client reports not going to work for the past week.
b. Client complains of not being able to “do anything”
anymore.
c. Client arrives at the clinic neat and appropriate in
appearance.
d. Client reports sleeping 12 hours per night and 3 to 4 hours
during the day.
1. D’ 66. B
2. C 67. A
3. A 68. D
4. A, F 69. B
5. C 70. C
6. D
7. A
8. A
9. D
10. A
11. A
12. B, C, D
13. A, B, D, E
14. D
15. A
16. D
17. C
18. C
19. B
20. D
21. B
22. A
23. A
24. C
25. C
26. A, C, D, F
27. A
28. D
29. C
30. B
31. B
32. B
33. A, B, C, E
34. A
35. A
36. A, C, D
37. B
38. B
39. D
40. B
41. D
42. C
43. B
44. C
45. D
46. B
47. D
48. B, C, D
49. A
50. B
51. C
52. A
53. A
54. C
55. C
56. B, C, E
57. B
58. D
59. D
60. B
61. D
62. B
63. C, E
64. B
65. B