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NR 508 Midterm study questions

NR 508 Midterm study questions 4. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients ____ 23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: 1. Reduce the chance of tardive dyskinesia 2. Potentiate the effects of the drug 3. Reduce the tolerance that tends to occur 4. Increase central nervous system (CNS) depression ____ 24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: 1. Insomnia 2. Weight gain 3. Hypertension 4. Galactorrhea ____ 25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: 1. Bradykinesia, akathisia, and agitation 2. Excessive weight gain 3. Hypertension 4. Potentially fatal agranulocytosis ____ 26. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: 1. Chlordiazepoxide (Librium) 2. Clonazepam (Klonopin) 3. Alprazolam (Xanax) 4. Oxazepam (Serax) ____ 27. A patient with anxiety and depression may respond to: 1. Duloxetine (Cymbalta) 2. Fluoxetine (Prozac) 3. Oxazepam (Serax) 4. Buspirone (Buspar) and an SSRI combined ____ 28. When prescribing temazepam (Restoril) for insomnia, patient education includes: 1. Take temazepam nightly approximately 15 minutes before bedtime. 2. Temazepam should not be used more than three times a week for less than 3 months. 3. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better. 4. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam. ____ 29. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: 1. Zolpidem should be taken just before going to bed. 2. Zolpidem may cause dry mouth and constipation. 3. Patients may need to double the dose for effectiveness. 4. They should stop drinking alcohol at least 30 minutes before taking zolpidem. ____ 30. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: 1. Orthostatic hypotension 2. Agitation and irritability 3. Drowsiness and nausea 4. Painful urination and abdominal distention ____ 31. Tom is taking lithium for bipolar disorder. He should be taught to: 1. Take his lithium with food 2. Eat a diet with consistent levels of salt (sodium) 3. Drink at least 2 quarts of water if he is in a hot environment 4. Monitor blood glucose levels ____ 32. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? 1. Valproate is safe during all trimesters of pregnancy. 2. She can get pregnant while taking valproate, but she should take adequate folic acid. 3. Valproate is not safe at any time during pregnancy. 4. Valproate is a known teratogen, but may be taken after the first trimester if necessary. ____ 33. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: 1. The medication may cause sedation and they should not drive. 2. Constipation is a common side effect and they should increase fluids and fiber. 3. Patients should not take any other acetaminophen-containing medications at the same time. 4. All of the above ____ 34. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol) ____ 35. Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: 1. Ibuprofen (Advil) 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol) ____ 36. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: 1. Slurred speech and insomnia 2. Bradycardia and confusion 3. Dizziness and orthostatic hypotension 4. Insomnia and decreased appetite ____ 37. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: 1. ADHD symptoms 2. Routine height and weight checks 3. Amount of methylphenidate being used 4. All of the above ____ 38. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: 1. Blood pressure 2. Blood glucose levels 3. Urine ketone levels 4. Liver function Chapter 15. Drugs Affecting the Central Nervous System Answer Section MULTIPLE CHOICE 1. ANS: 2 PTS: 1 2. ANS: 3 PTS: 1 3. ANS: 2 PTS: 1 4. ANS: 1 PTS: 1 5. ANS: 2 PTS: 1 6. ANS: 3 PTS: 1 7. ANS: 4 PTS: 1 8. ANS: 3 PTS: 1 9. ANS: 2 PTS: 1 10. ANS: 4 PTS: 1 11. ANS: 4 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 1 PTS: 1 14. ANS: 4 PTS: 1 15. ANS: 2 PTS: 1 16. ANS: 3 PTS: 1 17. ANS: 4 PTS: 1 18. ANS: 4 PTS: 1 19. ANS: 1 PTS: 1 20. ANS: 1 PTS: 1 21. ANS: 4 PTS: 1 22. ANS: 2 PTS: 1 23. ANS: 2 PTS: 1 24. ANS: 1 PTS: 1 25. ANS: 1 PTS: 1 26. ANS: 3 PTS: 1 27. ANS: 4 PTS: 1 28. ANS: 2 PTS: 1 29. ANS: 1 PTS: 1 30. ANS: 3 PTS: 1 31. ANS: 2 PTS: 1 32. ANS: 4 PTS: 1 33. ANS: 4 PTS: 1 34. ANS: 1 PTS: 1 35. ANS: 2 PTS: 1 36. ANS: 4 PTS: 1 37. ANS: 4 PTS: 1 38. ANS: 1 PTS: 1 Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? 1. Calcium channel blockers 2. Beta blockers 3. Angiotensin-converting-enzyme (ACE) inhibitors 4. Aspirin ____ 2. Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include: 1. Pulmonary embolism 2. Pneumonia 3. Gastroesophageal reflux 4. All of the above ____ 3. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class: 1. I 2. II 3. III 4. IV ____ 4. Patients at high risk for developing significant coronary heart disease are those with: 1. LDL values between 100 and 130 2. Systolic blood pressure between 120 and 130 3. Class III angina 4. Obesity ____ 5. To reduce mortality, all patients with angina, regardless of class, should be on: 1. Aspirin 81 to 325 mg/d 2. Nitroglycerin sublingually for chest pain 3. ACE inhibitors or angiotensin receptor blockers 4. Digoxin ____ 6. Patients who have angina, regardless of class, who are also diabetic, should be on: 1. Nitrates 2. Beta blockers 3. ACE inhibitors 4. Calcium channel blockers ____ 7. Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct. 1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. 2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. 3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. 4. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function. ____ 8. Nitrates are especially helpful for patients with angina who also have: 1. Heart failure 2. Hypertension 3. Both 1 and 2 4. Neither 1 nor 2 ____ 9. Beta blockers are especially helpful for patients with exertional angina who also have: 1. Arrhythmias 2. Hypothyroidism 3. Hyperlipidemia 4. Atherosclerosis ____ 10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use? 1. These drugs are useful for immediate symptom relief when the patient is certain it is angina. 2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. 3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911. 4. All of the above ____ 11. Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. and 2 p.m. because: 1. Long-acting forms have a higher risk for toxicity. 2. Orthostatic hypotension is a common adverse effect. 3. It must be taken with milk or food. 4. Nitrate tolerance can develop. ____ 12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because: 1. Nitrates increase MOS and beta blockers increase MOD. 2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 4. All of the above ____ 13. Drug choices to treat angina in older adults differ from those of younger adults only in: 1. Consideration of risk factors for diseases associated with and increased in aging 2. The placement of drug therapy as a treatment choice before lifestyle changes are tried 3. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult 4. Those with higher risk for silent myocardial infarction ____ 14. Which of the following drugs has been associated with increased risk for myocardial infarction in women? 1. Aspirin 2. Beta blockers 3. Estrogen replacement 4. Lipid-lowering agents ____ 15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT: 1. Patients often require multiple drugs 2. A large number of angina patients are older adults on fixed incomes 3. Generic formulations may be cheaper but are rarely bioequivalent 4. Lack of drug selectivity may result in increased adverse reactions ____ 16. Situations that suggest referral to a specialist is appropriate include: 1. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors 2. When a post-myocardial infarction patient develops new-onset angina 3. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina 4. All of the above ____ 17. The rationale for prescribing calcium blockers for angina can be based on the need for: 1. Increased inotropic effect in the heart 2. Increasing peripheral perfusion 3. Keeping heart rates high enough to ensure perfusion of coronary arteries 4. Help with rate control ____ 18. Medications are typically started for angina patients when: 1. The first permanent EKG changes occur 2. The start of class I or II symptoms 3. The events trigger a trip to the emergency department 4. When troponin levels become altered ____ 19. The most common cause of angina is: 1. Vasospasm of the coronary arteries 2. Atherosclerosis 3. Platelet aggregation 4. Low systemic oxygen ____ 20. Ranolazine is used in angina patients to: 1. Dilate plaque-filled arteries 2. Inhibit platelet aggregation 3. Restrict late sodium flow in the myocytes 4. Induce vasoconstriction in the periphery to open coronary vessels ____ 21. When is aspirin (ASA) used in angina patients? 1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons. 2. ASA should only be used in men. 3. ASA has no role in angina, but is useful in MI prevention. 4. The impact of ASA is best at the time of an angina attack. Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 4 PTS: 1 3. ANS: 2 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 1 PTS: 1 6. ANS: 3 PTS: 1 7. ANS: 2 PTS: 1 8. ANS: 3 PTS: 1 9. ANS: 1 PTS: 1 10. ANS: 3 PTS: 1 11. ANS: 4 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 1 PTS: 1 14. ANS: 3 PTS: 1 15. ANS: 3 PTS: 1 16. ANS: 4 PTS: 1 17. ANS: 4 PTS: 1 18. ANS: 2 PTS: 1 19. ANS: 2 PTS: 1 20. ANS: 3 PTS: 1 21. ANS: 1 PTS: 1 Chapter 36. Heart Failure Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors? 1. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently. 2. Reduced formation of cross-bridges so that contractile force decreases. 3. Activation of the sympathetic nervous system that increases heart rate and preload. 4. Decreased renal blood flow that decreases oxygen supply to the kidneys. ____ 2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include: 1. Myocardial ischemia and injury secondary to myocardial infarction 2. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction 3. Increased demands of the heart beyond its ability to adapt secondary to anemia 4. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension ____ 3. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage: 1. A 2. B 3. C 4. D ____ 4. Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is: 1. Chest x-rays that show cephalization and measure heart size 2. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction 3. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage 4. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction ____ 5. Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with: 1. Drugs for hypertension and hyperlipidemia, if they exist 2. Lifestyle management including diet, exercise, and smoking cessation only 3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart failure only 4. No drugs are used in this early stage ____ 6. Class I recommendations for stage A heart failure include: 1. Aerobic exercise within tolerance levels to prevent the development of heart failure 2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention 3. Beta blockers for all patients regardless of cardiac history 4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias ____ 7. Stage B patients should have beta blockers added to their heart failure treatment regimen when: 1. They have an ejection fraction less than 40% 2. They have had a recent MI 3. Both 1 and 2 4. Neither 1 nor 2 ____ 8. Increased life expectancy for patients with heart failure has been associated with the use of: 1. ACE inhibitors, especially when started early in the disease process 2. All beta blockers regardless of selectivity 3. Thiazide and loop diuretics 4. Cardiac glycosides ____ 9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? 1. Diuretics reduce preload associated with fluid retention. 2. Diuretics can be used earlier than stage C when the goal is control of hypertension. 3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism. 4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB). ____ 10. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with: 1. Ejection fractions above 40% 2. An audible S3 3. Mitral stenosis as a primary cause for heart failure 4. Renal insufficiency ____ 11. Which of the following classes of drugs is contraindicated in heart failure? 1. Nitrates 2. Long-acting dihydropyridines 3. Calcium channel blockers 4. Alpha-beta blockers ____ 12. Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is: 1. Aldosterone antagonists 2. Eplerenone 3. ACE inhibitors 4. ARBs ____ 13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy? 1. Diuretics 2. ARBs 3. Beta blockers 4. Nitrates ____ 14. Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: 1. Symptoms markedly worsen or the patient becomes hypotensive and has syncope 2. There is evidence of progressive renal insufficiency or failure 3. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic 4. Any of the above ____ 15. ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely? 1. Elderly patients with reduced renal clearance 2. Pregnant women 3. Women under age 30 4. 1 and 2 ____ 16. What assessment that can be done at home is the most reliable for making decisions to change HF medications? 1. Weight 2. BP 3. Heart rate 4. Serum Glucose ____ 17. Evidence is strong that the timing of HF interventions are best initiated when: 1. The person enters stage C 2. The person has functional disabilities 3. At the earliest indication 4. When stage IV is determined ____ 18. HF patients frequently take more than one drug. When are anticoagulants typically used? 1. When the patient enters stage III 2. Only in cases of diastolic failure 3. When there is concurrent A Fib 4. In all cases ____ 19. What can chest x-rays contribute to the diagnosis and management of HF? 1. They have no role. 2. They can give very precise pictures of pulmonary fluid status. 3. They provide an idea of general cardiac size and pulmonary great vessel distribution. 4. They can confirm the diagnosis. Chapter 36. Heart Failure Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 1 PTS: 1 3. ANS: 3 PTS: 1 4. ANS: 2 PTS: 1 5. ANS: 1 PTS: 1 6. ANS: 4 PTS: 1 7. ANS: 3 PTS: 1 8. ANS: 1 PTS: 1 9. ANS: 4 PTS: 1 10. ANS: 2 PTS: 1 11. ANS: 3 PTS: 1 12. ANS: 3 PTS: 1 13. ANS: 3 PTS: 1 14. ANS: 4 PTS: 1 15. ANS: 4 PTS: 1 16. ANS: 1 PTS: 1 17. ANS: 3 PTS: 1 18. ANS: 3 PTS: 1 19. ANS: 3 PTS: 1 Chapter 40. Hypertension Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: 1. Increase renin secretion 2. Decrease the production of aldosterone 3. Deplete body sodium and reduce fluid volume 4. Decrease blood viscosity ____ 2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement: 1. Potassium 2. Calcium 3. Magnesium 4. Phosphates ____ 3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are: 1. Those with orthostatic hypertension 2. African Americans 3. Those with stable angina 4. Diabetics ____ 4. Beta blockers treat hypertension because they: 1. Reduce peripheral resistance 2. Vasoconstrict coronary arteries 3. Reduce norepinephrine 4. Reduce angiotensin II production ____ 5. Which of the following disease processes could be made worse by taking a nonselective beta blocker? 1. Asthma 2. Diabetes 3. Both might worsen 4. Beta blockade does not affect these disorders ____ 6. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: 1. Heart failure 2. Angina 3. Myocardial infarction 4. Dyslipidemia ____ 7. Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they: 1. Reduce sodium and water retention 2. Decrease vasoconstriction 3. Increase vasodilation 4. All of the above ____ 8. Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes: 1. Pregnancy 2. Renal parenchymal disease 3. Stable angina 4. Dyslipidemia ____ 9. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? 1. Beta blockers 2. Diuretics 3. Nondihydropyridine calcium channel blockers 4. Angiotensin II receptor blockers ____ 10. If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents? 1. ACE inhibitors 2. Beta blockers 3. Calcium channel blockers 4. Diuretics ____ 11. Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true? 1. Hypertension is a chronic disease where patients may be taking drugs for a long time. 2. Most patients will require more than one drug to treat the hypertension. 3. The cost includes the price of any routine or special laboratory tests that a specific drug may require. 4. Few antihypertensive drugs come in generic formulations. ____ 12. Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement? 1. 15 2. 30 3. 60 4. 90 ____ 13. Blood pressure checks in children: 1. Should occur with their annual physical examinations after 6 years of age 2. Require a blood pressure cuff that is one-third the diameter of the child’s arm 3. Should be done during every health-care visit after 3 years of age 4. Require additional laboratory tests such as serum creatinine ____ 14. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: 1. Lifestyle changes are difficult to achieve and maintain. 2. Adverse drug reactions are common and often fall into the categories more associated with nonadherence. 3. Costs of drugs and monitoring with laboratory tests can be expensive. 4. All of the above ____ 15. Lifestyle modifications for patients with prehypertension or hypertension include: 1. Diet and increase exercise to achieve a BMI greater than 25. 2. Drink 4 ounces of red wine at least once per week. 3. Adopt the dietary approaches to stop hypertension (DASH) diet. 4. Increase potassium intake. ____ 16. Which diuretic agents typically do not need potassium supplementation? 1. The loop diuretics 2. The thiazide diuretics 3. The aldosterone inhibitors 4. They all need supplementation ____ 17. Aldactone family medications are frequently used when the hypertensive patient also has: 1. Hyperkalemia 2. Advancing liver dysfunction 3. The need for birth control 4. Rheumatoid arthritis ____ 18. Hypertensive African Americans are typically listed as not being as responsive to which drug groups? 1. ACE inhibitors 2. Calcium channel blockers 3. Diuretics 4. Bidil (hydralazine family of medications) ____ 19. What educational points concerning fluid intake must be covered with diuretic prescriptions? 1. Fluid should be restricted when on them. 2. Fluids should contain at least one salty item daily. 3. Fluid intake should remain near normal for optimal performance. 4. Avoidance of potassium-rich fluids is encouraged. ____ 20. What is a common side effect concern with hypertensive medications and all individuals, but especially the elderly? 1. Risk of falls 2. Triggering of a hypertensive crisis 3. Erectile priapism 4. Risk for bladder cancer development Chapter 40. Hypertension Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 1 PTS: 1 3. ANS: 2 PTS: 1 4. ANS: 1 PTS: 1 5. ANS: 3 PTS: 1 6. ANS: 3 PTS: 1 7. ANS: 4 PTS: 1 8. ANS: 2 PTS: 1 9. ANS: 3 PTS: 1 10. ANS: 4 PTS: 1 11. ANS: 4 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 3 PTS: 1 14. ANS: 4 PTS: 1 15. ANS: 3 PTS: 1 16. ANS: 3 PTS: 1 17. ANS: 2 PTS: 1 18. ANS: 1 PTS: 1 19. ANS: 3 PTS: 1 20. ANS: 1 PTS: 1

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