Represent mulit-select choice where one choice is exclusive

[Will Lucic]

What would be a good way to represent answers to questions that allow you to select multiple choices, but where one choice is exclusive. Ex:

Select all that apply:
A) First
B) Second
C) Third
D) None apply

Any combination of A, B, and C are valid, but D cannot be chosen alongside other choices.
Answering is also optional.

If I have a "choices" table with choice ids and text, and a "responses" table with responder ids and choice ids (multiple rows for a responders that choose multiple), could I put a constraint on the "responses" table so that choice "D)" is exclusive?

If so, I'm not sure how to create a constraint that checks existing table contents.
I'm also not convinced that a constraint would be a good solution.