The answer is A., it makes it feel as if you're shouting at the reading. Exclamation marks are used to show lots of emotion, as sometimes it is also used for shouting.
B., C., and D. all are completely not related.
Your opinion can be expressed with exclamation marks, it won't confuse anyone. Like I said, exclamation marks are used to show lots of fire and emotion. It wouldn't confuse anyone.
Exclamation marks do not confuse the main point. The reasoning for why it isn't C is similar to the reasoning for B. Exclamation marks do not change the main point.
C. is pretty much the opposite. Exclamation marks are used for emotions, not to show no emotion.
The best answer to this question would be the organizational structure of a text. When you look up the definition of format, the definition is not in your options, but answer a is the most similar one.
Hope this helps!!
idk what the sentence above is, but it's probably C) Several cities with large populations have many asthma-related health problems.
