REFA exit exam questions and answers — Refresher Elementary First Aid
All 155 questions from the Refresher Elementary First Aid (REFA) exit exam bank, with the correct option marked and a one-line explanation for every one. Read it end to end, jump to a single set, or search it — then sit the same bank as a timed paper. The real DG Shipping exit exam is 30 marks with 15 to pass.
These are the bank's original groupings. Practising deals the whole bank out again every time you reshuffle, so a practice “Set 3” is a different 30 questions each time — the set numbers below are the source file's, and are only used here so the key stays navigable. Options are listed in their original order with fixed letters; when you practise, those move too.
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Set 1 — 30 REFA exit exam questions with answers
1. Which fire extinguisher is most prone to freezing when stowed in low temperature?
- A. Halon 1211
- B. Carbon dioxide
- C. Foam
- D. Dry chemical
Answer: C — Foam
Foam extinguishers contain a water-based solution, so they can freeze when stored at low temperatures. CO2, dry chemical and halon extinguishers contain no water and do not freeze in normal low-temperature stowage.
2. You discover a particle embedded in the casualty cornea. You should
- A. Remove the particle with a moist corner of a facial tissue or clean cloth
- B. Flush the eye with water for 10 min
- C. Use a splinter force to remove the particle
- D. Cover the eye and transport the casualty to medical help
Answer: D — Cover the eye and transport the casualty to medical help
A particle embedded in the cornea must not be removed by a first aider, as trying to do so can cause permanent eye damage. The eye should be covered, ideally both eyes to reduce movement, and the casualty taken for medical help.
3. After an extremity fracture has been immobilised, the responder should check for circulation
- A. In the injured limb only
- B. Distal to the injury
- C. Proximal to the injury
- D. At the site of the fracture
Answer: B — Distal to the injury
Once a limb fracture is splinted, circulation, sensation and movement are checked distal to the injury, that is, beyond it towards the fingers or toes. A cold, pale or numb extremity shows the splint or bandage is too tight and must be loosened.
4. When performing adult CPR you give
- A. 2 slow breaths and 30 chest compressions
- B. 1 slow breaths and 10 chest compressions
- C. 5 slow breaths and 10 chest compressions
- D. 3 slow breaths and 15 chest compressions
Answer: A — 2 slow breaths and 30 chest compressions
Current resuscitation guidelines for adult CPR use a ratio of 30 chest compressions to 2 rescue breaths, at a compression rate of 100 to 120 per minute. This cycle continues until help arrives, an AED is ready or the casualty recovers.
5. What method of handling you see if victim is unconscious
- A. Pick a back method
- B. Fireman lift
- C. Simple fore and aft carry
- D. Both B and C
Answer: D — Both B and C
An unconscious casualty cannot help the rescuers, so carries that support the full body weight are used. The fireman's lift, done by one rescuer, and the fore-and-aft carry, done by two rescuers, are both suitable, whereas a piggyback needs the casualty to hold on.
6. A faint is a brief loss of consciousness of more than momentary duration caused by a temporary reduction in the flow of blood to the brain. How would you prevent anyone from fainting ?
- A. If standing in a crowd, flex the leg muscles and toes to aid circulation
- B. Try to keep the person in an upstanding position
- C. Tell the person to sit down in a sitting position breathing normally
- D. Tell the person to sit down and lean forward with the head between the knees taking deep breaths
Answer: D — Tell the person to sit down and lean forward with the head between the knees taking deep breaths
Someone who feels faint should sit down, lean forward and put their head between their knees while breathing deeply. This helps blood flow back to the brain and can prevent a full faint.
7. What is the most important thing to do if you think someone is having a heart attack ?
- A. Give aspirin and wait to see
- B. Help the person lie down
- C. Call the persons doctor
- D. Call medical help
Answer: D — Call medical help
With a suspected heart attack, the most important action is to call for medical help immediately. Early specialist treatment greatly improves survival, and on board this means contacting radio medical advice (TMAS) while keeping the casualty at rest.
8. To safety perform a chair carry you need ?
- A. 2 rescuers
- B. 3 rescuers
- C. 4 rescuers
- D. 5 rescuers
Answer: A — 2 rescuers
In a chair carry, two rescuers seat the casualty on a sturdy chair and lift it, one at the back and one at the front by the legs of the chair. It is useful for carrying a conscious casualty through narrow passages and stairways.
9. What is the best way to remove a tick ?
- A. Smoother it in butter
- B. Lift it put carefully with tweezers
- C. Scrape it off with a hard, flat object like a credit card
- D. Burn it off with a hot match
Answer: B — Lift it put carefully with tweezers
A tick is best removed by grasping it with fine tweezers close to the skin and pulling steadily without twisting or squeezing. Butter, heat or scraping can make the tick release more infected fluid or leave its mouthparts in the skin.
10. You have a casualty that is muttering to themselves but not making any sense. The face appears to be dropping in one side what might be wrong with them ?
- A. They are have a heart attack
- B. They are in shock after witnessing an accident
- C. They may be having a stroke
- D. None of the above
Answer: C — They may be having a stroke
Confused or slurred speech together with drooping on one side of the face are classic signs of a stroke, as recognised by the FAST test (face, arms, speech, time). Urgent medical help is needed, because early treatment limits brain damage.
11. Urine enters the bladder through which structure ?
- A. Ureters
- B. Collecting duct
- C. Kidney
- D. Urethra
Answer: A — Ureters
Urine produced in the kidneys travels down two thin tubes called ureters into the bladder. It is stored there and later passed out through the urethra.
12. What damage could occur if first aider’s hand are placed at hte tip of the sternum during heart compression ?
- A. The patient may vomit as his stomach is squeezed
- B. The lungs may be punctured leading to severe loss of breath
- C. The ribs might be cracked
- D. The liver might be torn leading to severe internal bleeding
Answer: D — The liver might be torn leading to severe internal bleeding
The tip of the sternum is the xiphoid process. Compressing over it can drive it into the liver, causing laceration and severe internal bleeding, so hands must be placed on the centre of the chest over the lower half of the breastbone, above the xiphoid.
13. When caring for a chocking infant what position is the infant held ?
- A. Upside down by ankles and shoulders
- B. Face up on flat surface
- C. Face down on your fore arm with head lower than the body
- D. Face down on your knee with head lower than the body
Answer: C — Face down on your fore arm with head lower than the body
A choking infant is held face down along the rescuer's forearm with the head lower than the body, while the jaw and head are supported. Up to five back blows are then given between the shoulder blades, and gravity helps dislodge the obstruction.
14. Signs that hernia is serious include
- A. Pain and tenderness at site
- B. Pale, ashen skin colour at site
- C. Hernia can be pushed back into the body
- D. Hernia is above the diaphragm
Answer: A — Pain and tenderness at site
Pain and tenderness at the hernia site that worsens or persists suggests the bowel may be trapped or strangulated, which is a surgical emergency. A hernia that can be gently pushed back is reducible and less urgent; increasing pain needs prompt radio medical advice and evacuation planning.
15. How you should react to an emergency ?
- A. Asses the scene for safety
- B. Estimate the number of victims and call help
- C. Get the first aid kit put on PPE before helping
- D. All of the above
Answer: D — All of the above
A first aider must first check the scene is safe, then estimate casualties and call for help, and prepare the first aid kit and protective gloves before touching anyone. All of these actions together form the correct initial response to any emergency, as taught in the STCW elementary first aid course.
16. The proper stimulant for unconscious person is
- A. Tea
- B. Coffee
- C. Whiskey and water
- D. Ammonia inhalant
Answer: D — Ammonia inhalant
Smelling salts (ammonia inhalant) were traditionally the recognised stimulant for a fainted or unconscious person because inhaled ammonia irritates the nasal lining and triggers a breathing reflex. Nothing should ever be given by mouth to an unconscious casualty, so tea, coffee or alcohol are dangerous.
17. If someone suffers heart attack and has ceased breathing, you should ?
- A. Immediately give stimulant by force if necessary
- B. Make the victim comfortable in a bunk
- C. Immediately start CPR
- D. Administer oxygen
Answer: C — Immediately start CPR
A heart attack victim who has stopped breathing is in cardiac arrest, so CPR must be started immediately to keep oxygenated blood flowing to the brain and heart. Every minute of delay greatly reduces survival; oxygen or comfort measures are of no use without circulation.
18. A communicate fracture is one where the bone has
- A. Broken into pieces which are floating.
- B. Broken where only part of the bone is fractured
- C. Broken clearly with each and attached
- D. Broken and is affecting muscles and nerve
Answer: A — Broken into pieces which are floating.
A comminuted fracture is one in which the bone is shattered into several fragments at the break site. Such fractures are usually caused by high-energy impact, are unstable and need careful immobilisation with splints before the casualty is moved.
19. In order to initiate CPR on a drowning victim
- A. Start chest compression before the victim is removed from the water
- B. Drain water from the lungs before ventilating
- C. Begin mouth-to-mouth ventilation
- D. Do not lit the head back since it may cause vomiting
Answer: C — Begin mouth-to-mouth ventilation
Drowning causes cardiac arrest from lack of oxygen, so resuscitation begins with rescue breaths to oxygenate the lungs. Attempting to drain water from the lungs wastes time and is ineffective, and compressions cannot be performed properly while the casualty is still in the water.
20. Some people are very allergic to insect bites and stings. The condition is called ______.
- A. Septic chock
- B. Cardiac arrest
- C. Toxic shock and syndrome
- D. Anaphylactic shock
Answer: D — Anaphylactic shock
Anaphylactic shock is a severe, life-threatening allergic reaction that can follow insect bites or stings, causing airway swelling, breathing difficulty and collapse of blood pressure. It is treated with an adrenaline auto-injector and urgent medical assistance.
21. Heat stroke attack bodies vital organs except
- A. Brain
- B. Heart
- C. Kidney
- D. Bones
Answer: D — Bones
Heat stroke is a failure of body temperature control that damages vital organs such as the brain, heart and kidneys, and can be fatal. Bones are not vital organs and are not directly affected, which is why they are the exception here.
22. When performing abdominal thrust how many thrust do you do ?
- A. 1 to 5 thrust
- B. 6 to 10 thrust
- C. 15 to 20 thrust
- D. 30 to 40 thrust
Answer: A — 1 to 5 thrust
Current resuscitation guidance (ERC and Red Cross) for a choking adult is to give up to five back blows followed by up to five abdominal thrusts, checking after each thrust whether the obstruction has cleared and repeating the cycle as needed.
23. What does the ABC’s for first aid stand for ?
- A. The letters in the alphabet b. c. * d.
- B. Air, breathing, circulation
- C. Airway , breathing, circulation
- D. None of the above
Answer: C — Airway , breathing, circulation
ABC stands for Airway, Breathing and Circulation, the order in which a first aider assesses and treats a casualty. An open airway is essential before breathing can be checked, and circulation is then assessed and supported.
24. If a person is chocking you should do nothing as long as
- A. They are coughing
- B. They are still conscious
- C. Their face has not turned blue
- D. They start crying
Answer: A — They are coughing
If a choking person can still cough forcefully, the airway is only partly blocked and coughing is the most effective way to clear it. The first aider should encourage coughing and watch closely, intervening with back blows and thrusts only if the cough becomes ineffective.
25. Before giving CPR you should make sure ?
- A. They are not bleeding
- B. They are conscious or unconscious
- C. They are not vomiting
- D. They are not dead
Answer: B — They are conscious or unconscious
Before starting CPR the first aider must check whether the casualty is responsive (conscious or unconscious) and breathing normally. CPR is given only to an unresponsive person who is not breathing normally, so checking responsiveness is the essential first step.
26. You are alone and administering CPR to an victim. How many chest compression and how many inflations should you administer in each sequence ?
- A. 15 compression then 2 inflations
- B. 15 compression then 4 inflations
- C. 30 compression then 2 inflations
- D. 30 compression then 4 inflations
Answer: C — 30 compression then 2 inflations
For a lone rescuer giving adult CPR, the standard ratio is 30 chest compressions followed by 2 rescue breaths, repeated continuously. Compressions are given at 100 to 120 per minute to a depth of about 5 to 6 cm.
27. The content of the first aid kit include the following except
- A. Micropore
- B. Macropore
- C. Bandages
- D. Scissor
Answer: B — Macropore
A standard first aid kit contains items such as Micropore surgical tape, bandages, dressings and scissors. "Macropore" is not a recognised first aid item, so it is the exception.
28. Advance communications system and technology stipulated by WHO where medical advice can be sought by
- A. Tele medicine
- B. Satellite communication
- C. Radio medical advice
- D. Compulsory in board specialized
Answer: A — Tele medicine
Telemedicine (TMAS) is the advanced communications-based system for getting medical advice at sea.
29. Which of the following is not a good approach to managing stress
- A. Talking directly to the person who is causing the stress
- B. Giving yourself a treat like comfort food or a cocktail
- C. Accepting that there are things beyond your control
- D. Trying cognitive-therapy to learn new coping skills
Answer: B — Giving yourself a treat like comfort food or a cocktail
Using comfort food or alcohol to cope with stress is an unhealthy avoidance strategy that can lead to weight gain, dependence and more stress. Addressing the source directly, accepting what cannot be controlled and cognitive therapy are all recognised healthy approaches.
30. A high-fiber, low-fat diet and regular exercise can help to ____.
- A. Increase CVD
- B. Increase weight
- C. Lose weight
- D. None
Answer: C — Lose weight
A high-fibre, low-fat diet combined with regular exercise reduces calorie intake and burns energy, which helps a person lose weight. It also lowers the risk of cardiovascular disease, which is important for seafarers with limited activity on board.
Set 2 — 30 REFA exit exam questions with answers
1. Which of the following is a laboratory procedure developed to provide an objective behavioural measure of the tendency to binge eat
- A. Palatability test
- B. Food pre-load test
- C. Full capacity test
- D. Fully loaded test
Answer: B — Food pre-load test
The food pre-load test is a laboratory procedure in which a person eats a set food item first and is then given free access to food, giving an objective behavioural measure of the tendency to binge or overeat.
2. Pick one of the following familial factors that plays a role in the development of eating disorders ?
- A. Parental attitudes to sex
- B. Parental obesity
- C. Parental attitudes to the media
- D. Parental attitudes to education
Answer: B — Parental obesity
Parental obesity is a recognised familial risk factor in the development of eating disorders, through both genetic influence and family eating habits and attitudes to weight and shape.
3. Body dissatisfaction is associated with triggering bouts of
- A. Purging
- B. Binging
- C. Dieting
- D. Shopping
Answer: C — Dieting
Body dissatisfaction commonly leads a person to start strict dieting, which in turn is a key trigger in the cycle of eating disorders. Restrictive dieting is regarded as the first step towards binging and purging behaviour.
4. The accepted treatment for a sprained ankle is
- A. remove the shoe and check for swelling using the capillary reflex method
- B. keep the shoe on apply an ankle bandage for support, elevate and apply cold towels
- C. keep the shoe on, apply an ankle splint and apply heat if possible
- D. have the victim walk or move as soon as possible to prevent stiffness
Answer: B — keep the shoe on apply an ankle bandage for support, elevate and apply cold towels
For a sprained ankle the shoe is left on to limit swelling, an ankle bandage gives support, and the limb is elevated with cold applied. This follows the rest, ice, compression and elevation principle used in elementary first aid.
5. A crew has his finger severed off, what action would be the best ?
- A. Put the severed end of the finger back in the place wrap entire finger in sterile gauze and transport to hospital immediately
- B. Wrap the severed finger in sterile gauze place it in a plastic bag, put the bag on ice transport both finger and the victim to the hospital
- C. Place the severed finger in a plastic bag have the crew place the bag under his armpit transport immediately to the hospital
- D. Place a tourniquet at the stub where the finger severed to control bleeding transport to hospital immediately
Answer: B — Wrap the severed finger in sterile gauze place it in a plastic bag, put the bag on ice transport both finger and the victim to the hospital
The amputated part should be wrapped in sterile gauze, sealed in a plastic bag and kept cool on ice without direct contact, then taken with the casualty to hospital. This preserves tissue for possible reattachment while bleeding at the stump is controlled with direct pressure.
6. When performing CPR on a child how deep should the chest compression be ?
- A. 1 1/2 inches
- B. 2 inches
- C. 2 1/2 inches
- D. 3 inches
Answer: B — 2 inches
Current resuscitation guidelines state that chest compressions on a child should be at least one third of the depth of the chest, about 5 cm or 2 inches. Shallower compressions do not generate adequate blood flow to the brain and heart.
7. Which of the following techniques is not suitable for moving an unconscious victim ?
- A. Improvised stretcher
- B. Four handed seat carry
- C. Two person carry
- D. Blanket drag
Answer: B — Four handed seat carry
The four-handed seat carry requires the casualty to be conscious and able to hold on to the bearers' shoulders. It is therefore unsuitable for an unconscious victim, who should be moved by stretcher, blanket drag or another fully supported method.
8. Which of the following correctly describes the CPR technique for an adult
- A. Four cycle for 15 compressions followed by one breath each minute
- B. one cycle of one breath and 10 compression each 2 to 3 inches deep per minute
- C. twelve cycles of one breath and 5 compressions per minute
- D. four cycles of Two breaths and 15 compressions per minutes
Answer: D — four cycles of Two breaths and 15 compressions per minutes
Under the older CPR standard taught in many first aid manuals, an adult received cycles of 15 compressions and 2 breaths, about four cycles per minute. Current guidelines have since changed this ratio to 30 compressions and 2 breaths.
9. Severe bleeding is a “hurry case” . which one of the following statements is true
- A. Bleeding can seldom be stopped with direct pressure
- B. A tourniquet is almost always required to control serious bleeding
- C. Should the first sterile pad used become blood soaked, immediately remove it and apply another
- D. Try to avoid direct contact with the victim’s blood by using latex gloves or another barriers
Answer: D — Try to avoid direct contact with the victim’s blood by using latex gloves or another barriers
First aiders should avoid direct contact with a casualty's blood by using latex or nitrile gloves or another barrier, to reduce the risk of transmitting blood-borne infections such as hepatitis B and HIV. Most bleeding can be controlled with direct pressure.
10. A person indicates that he was bitten by a snake what do you do ?
- A. Apply ice to the wound and take to the nearest fire station or hospital
- B. wash the wound keeping injured area lower than the heart get professional medical care within 30 minutes
- C. cut a 1” cross at the site if injury and suck the poison out apply ice
- D. elevate injured area apply ice and get professional medical care within 30 minutes
Answer: B — wash the wound keeping injured area lower than the heart get professional medical care within 30 minutes
For a snakebite, wash the wound, keep the casualty still with the bitten part below heart level to slow spread of venom, and get professional medical care quickly. Cutting the wound, sucking the venom or applying ice are harmful and no longer recommended.
11. What should you do if you think the victim are serious internal bleeding
- A. Apply heat to the injured area
- B. Give fluids to replace blood loss
- C. Call for medical assistance as quick as possible
- D. Place the victim in a sitting position
Answer: C — Call for medical assistance as quick as possible
Serious internal bleeding cannot be controlled by first aid on board, so urgent medical assistance must be obtained as quickly as possible, through radio medical advice if at sea. Meanwhile treat for shock and give nothing by mouth.
12. To treat first degree burn you should ……
- A. Apply a good quality burn cream or ointment
- B. Clean the area thoroughly with hot soapy water
- C. Apply a constricting band between the burn and the heart
- D. Apply cool running water until there is little or no remaining pain
Answer: D — Apply cool running water until there is little or no remaining pain
A first-degree burn should be cooled under cool running water until the pain is relieved, which stops further tissue damage. Creams, ointments and hot water are not used, and constricting bands must never be applied.
13. What do you do for a victim who has a bleeding injury to the mouth and you are sure about that there is no head neck or spine injury
- A. Keep victim seated with head tilted slightly forward
- B. Keep victim seated with head tilted slightly backward
- C. Have the victim lie down on their side
- D. None of the above
Answer: A — Keep victim seated with head tilted slightly forward
Seat the casualty with head tilted forward so blood drains out of the mouth and is not swallowed or inhaled.
14. The accepted treatment for a nose bleed
- A. Use direct pressure elevation and pressure points to control the bleeding
- B. Tilt the head back and tightly squeeze the nostrils
- C. Have the victim lean forward apply gentle pressure on the nostril apply cold towels
- D. Lay the victim on his back and treat foe shock apply heat if available
Answer: C — Have the victim lean forward apply gentle pressure on the nostril apply cold towels
For a nosebleed, have the casualty sit and lean forward, apply gentle pressure on the soft part of the nostrils and use cold towels. Leaning forward stops blood running down the throat, which could cause choking or vomiting.
15. What treatment does a victim who’s life threatening condition is “not breathing” need ?
- A. The Helimich maneuver two rescue breaths and CPR
- B. Start CPR immediately
- C. Twelve to fifteen recue breaths per min and correct CPR
- D. You should follow the steps for rescue breathing
Answer: D — You should follow the steps for rescue breathing
A casualty who is not breathing but still has a pulse needs rescue breathing, giving breaths into the lungs at the recommended rate while checking for circulation. If the pulse is also absent, full CPR is required.
16. Internal bleeding can be caused by
- A. Injury
- B. Illness
- C. Medication
- D. All of the above
Answer: D — All of the above
Internal bleeding may result from injuries such as blunt trauma or fractures, from illnesses such as ulcers, and from medications such as anticoagulants. Because all of these are causes, any of them should raise suspicion.
17. What is the appropriate treatment for a suspected broken collarbone or shoulder ?
- A. Apply a simple sling. Bind the sling to the chest with a cravat
- B. Use the cross your heart padded chest support system
- C. Use the flail chest protection system
- D. Apply a modified “Johnson traction splint”
Answer: A — Apply a simple sling. Bind the sling to the chest with a cravat
A suspected broken collarbone or shoulder is supported with a simple arm sling, then bound to the chest with a broad cravat to immobilise the arm. This reduces movement at the fracture and relieves pain.
18. What would you do if a victim had a body part torn or cut off ?
- A. Wrap severe body part in sterile gauze
- B. Place in a plastic bag
- C. Put the plastic bag on ice and take it to the hospital with victim
- D. All of the above
Answer: D — All of the above
An amputated body part should be wrapped in sterile gauze, placed in a plastic bag, and the bag put on ice and taken to hospital with the casualty. All these steps together preserve the part for possible surgical reattachment.
19. When performing CPR on a child you give ……
- A. 4 slow breaths & 20 chest compressions
- B. 1 slow breaths & 5 chest compressions
- C. 2 slow breaths & 10 chest compressions
- D. 2 slow breaths & 15 chest compressions
Answer: D — 2 slow breaths & 15 chest compressions
When two rescuers perform CPR on a child, the recommended ratio is 15 chest compressions to 2 rescue breaths. A lone rescuer uses 30 compressions to 2 breaths.
20. White or greyish yellow patches on someone’s ears noses or checks are signs of
- A. Frostbite
- B. Cold related stress disorder
- C. Anaphylactic shock
- D. Hypothermia
Answer: A — Frostbite
White or greyish-yellow, waxy patches on exposed parts such as the ears, nose or cheeks are classic signs of frostbite, where the tissue has frozen. The area should be rewarmed gently and not rubbed.
21. The emergency responder is one link in the chain of services known as the
- A. Emergency crew care (ECC) system
- B. Emergency medical services (EMS) system
- C. Professional emergency care (PEC) system
- D. Community medical care (CMC) system
Answer: B — Emergency medical services (EMS) system
The emergency responder is one link in the Emergency Medical Services (EMS) system, the chain that runs from first aid at the scene through ambulance or medevac transport to hospital care.
22. To reduce the risk of respiratory infection and pneumonia where medical care is delayed, responders should
- A. Have the patient breathe deeply and cough
- B. Provide the patient with adequate hydration
- C. Position the patient in the position of comfort
- D. Ensure the patient is kept warm and t rest
Answer: A — Have the patient breathe deeply and cough
When medical care is delayed, a patient who breathes deeply and coughs regularly keeps the lungs expanded and clears secretions. This reduces the risk of chest infection and pneumonia, especially in casualties who are immobile.
23. The best way to prevent a critical incident stress situation from becoming worse is
- A. Ignore it
- B. Be familiar with the signs and symptoms
- C. Ensure early use of proper medication
- D. Force the responder to talk about the situation
Answer: B — Be familiar with the signs and symptoms
Being familiar with the signs and symptoms of critical incident stress allows responders and colleagues to recognise it early and get support in time. Ignoring it, or forcing someone to talk, can make the reaction worse.
24. Which of the following is sign of severe airway obstruction ?
- A. Forceful cough
- B. Wheezing
- C. High pitched inhalation noise
- D. All of the above
Answer: C — High pitched inhalation noise
A high-pitched noise while breathing in (stridor) shows that the airway is severely blocked. A forceful cough means the obstruction is only partial and the casualty should be encouraged to keep coughing, so a forceful cough is a sign of mild obstruction.
25. Why is CPR important ?
- A. It provides a small supply of blood and oxygen to the brain and vital organs
- B. It keeps the heart breaking
- C. It keeps the aorta from collapsing
- D. It prevent cardiac arrest
Answer: A — It provides a small supply of blood and oxygen to the brain and vital organs
CPR keeps a small but vital flow of oxygenated blood going to the brain and other vital organs until defibrillation or advanced care is available. It does not restart the heart by itself, but it delays brain damage.
26. What is the name of the type of stretcher often found on board ?
- A. The canvas pole stretcher
- B. The Neil Robertson stretcher
- C. The SOLAS stretcher
- D. The Heart Imco stretcher
Answer: B — The Neil Robertson stretcher
The Neil Robertson stretcher is the standard stretcher carried on merchant ships. It wraps and supports the casualty firmly, so they can be lifted vertically through hatches, up ladders and out of enclosed spaces.
27. A crew o your ship has a severe cut in the groin area what do you do ?
- A. Cover the wound with a sterile dressing applying direct pressure
- B. Elevate the student’s feet and apply a sterile dressing to the wound, ply pressure to groin area
- C. Drive the bus to nearest hospital or fire station
- D. Cover wound with sterile dressing and apply pressure to femoral artery pressure
Answer: A — Cover the wound with a sterile dressing applying direct pressure
A severe groin wound is controlled first by covering it with a sterile dressing and applying firm direct pressure. Direct pressure is the main method for controlling external bleeding before any other measures.
28. What symptoms would indicate internal bleeding ?
- A. Rapid weak pulse, excessive thirst
- B. Skin that feels cold or moist, or look pale or bluish
- C. Tender, swollen, bruised or hard areas of his body, such as abdomen
- D. All of the above
Answer: D — All of the above
Signs of internal bleeding include a rapid weak pulse, excessive thirst, cold clammy pale or bluish skin, and tender, swollen, bruised or hard areas such as the abdomen. All of these indicate shock from blood loss.
29. Which arteries pressure point is located on front of upper leg jus below the middle of crease of groin ?
- A. Radial artery
- B. Popliteal artery
- C. Branchial artery
- D. Femoral artery
Answer: D — Femoral artery
The femoral artery pressure point lies on the front of the upper thigh just below the middle of the groin crease. Pressing the artery against the pelvis here can reduce severe bleeding from the leg.
30. When communicating with patients
- A. Stay at eye level and maintain eye contact
- B. Stay as close to the patient as possible
- C. Use medical terminology to enhance credibility
- D. Hide facts of the situation is serious
Answer: A — Stay at eye level and maintain eye contact
Staying at the patient's eye level and keeping eye contact builds trust, reduces fear and helps the casualty cooperate. Plain language is better than medical jargon, and the first aider should be honest without causing alarm.
Set 3 — 30 REFA exit exam questions with answers
1. If you are the first person to discover the fire, what should you do ?
- A. Leave the building immediately
- B. Head to your locker and get your personal items
- C. Pick up a fire extinguisher and tackle the fire
- D. Activate the fire alarm
Answer: D — Activate the fire alarm
The person who discovers a fire must raise the alarm immediately, using the nearest manual call point, so the crew and the emergency response are started. Early alarm is the first step in all shipboard fire procedures.
2. Your role in making the first aid successful work effectively includes four steps
- A. Elevate, identify, decide, execute
- B. Check, cal, care, protect
- C. Recognize, decide, call, provide
- D. None of the above
Answer: C — Recognize, decide, call, provide
The four steps for effective first aid are to recognise that an emergency exists, decide to act, call for help and provide care until help takes over. These steps help the first aider respond quickly and in order.
3. Where does the partly digested food ( in liquid form) goes after it leaves stomach ?
- A. Gullet
- B. Appendix
- C. Small intestine
- D. Large intestine
Answer: C — Small intestine
After leaving the stomach, the partly digested liquid food (chyme) passes into the small intestine, where most digestion and absorption of nutrients take place before the remainder moves into the large intestine.
4. You have someone who is pale, sweating, profusely, trembling and acting aggressively. They appear drunk but do not smell of alcohol. What may be wrong with them ?
- A. They are suffering from a diabetic emergency
- B. They are suffering from a heart attack
- C. They are suffering from an epileptic seizure
- D. They are suffering from a stroke
Answer: A — They are suffering from a diabetic emergency
Paleness, heavy sweating, trembling and aggressive or confused behaviour that looks like drunkenness without any smell of alcohol are classic signs of hypoglycaemia, a diabetic emergency. Giving sugar if the casualty is conscious can quickly reverse it.
5. Pelvic fracture can cause severe and even life threatening bleeding in to the
- A. Pelvic areas
- B. Abdominal cavities
- C. Large intestine
- D. A & B
Answer: D — A & B
A fractured pelvis can damage large blood vessels and cause severe, life-threatening internal bleeding into both the pelvic area and the abdominal cavity. This is why such casualties often show signs of shock.
6. What symptoms are associated with heat exhaustion_____
- A. Cool, moist, pale, or flushed skin
- B. Rapid weak pulse
- C. Rapid, shallow breathing
- D. All of the above
Answer: D — All of the above
Heat exhaustion produces cool, moist, pale or flushed skin, a rapid weak pulse and rapid shallow breathing, together with headache, nausea and weakness. All the listed signs are typical of the condition.
7. On an infant, if you are the lone rescuer, you should perform compressions
- A. Using to finger just below the nipple line
- B. Using the heel of one hand just below he nipple line
- C. Using the heal of two hands just below the nipple line
- D. None of the above
Answer: A — Using to finger just below the nipple line
A lone rescuer gives infant chest compressions with two fingers just below the nipple line in the centre of the chest. The infant's chest is small and fragile, so two fingers give the correct depth of about 4 cm.
8. On an infant where you check the pulse ?
- A. Inside the wrist just above the hand
- B. On the neck to the right or left side of the wind pipe
- C. Behind the knee cap
- D. Inside the arm between the elbow and shoulder
Answer: D — Inside the arm between the elbow and shoulder
In an infant, the pulse is checked at the brachial artery on the inside of the upper arm between the elbow and shoulder. The neck of an infant is too short for reliable use of the carotid pulse.
9. A burn should be immersed or placed under water for at least ______ minutes
- A. 5 min
- B. 10 min
- C. 15 min
- D. 20 min
Answer: B — 10 min
A burn should be cooled under cool running water for at least 10 minutes to stop the burning process, reduce pain and limit tissue damage. Many current guidelines now recommend up to 20 minutes.
10. When caring for someone who has suffered an electric shock, you would not ______
- A. Check breathing and pulse
- B. Check for possible fractures
- C. Cool the burned areas
- D. Treat for shock
Answer: B — Check for possible fractures
In electric shock, the priorities are breathing and pulse, cooling the entry and exit burns and treating for shock. Looking for fractures is not a first priority for electric shock care, so it is the step not normally taken.
11. What is an open fracture ?
- A. A fracture in which the bone ends can move around
- B. A fracture in which the bone is exposed as the skin is broken
- C. A fracture which causes complications such as a punctured lung
- D. A fracture in which the bone has bent and split
Answer: B — A fracture in which the bone is exposed as the skin is broken
An open (compound) fracture is one where the broken bone has pierced the skin or there is an open wound leading to the fracture. It carries a high risk of infection and serious bleeding.
12. How should you pen the airway of an unconscious casualty ?
- A. Head tilt and chin lift
- B. Jaw thrust
- C. Head tilt and jaw thrust
- D. Lift the chin
Answer: A — Head tilt and chin lift
The head-tilt chin-lift manoeuvre is the standard way for a first aider to open the airway of an unconscious casualty, lifting the tongue away from the back of the throat. The jaw thrust is used mainly when spinal injury is suspected.
13. What steps would you take to control bleeding from a nose bleed ?
- A. Sit casualty down, lean forward and pinch soft part of nose
- B. Sit casualty down, lean backward and pinch soft part of nose
- C. Lie casualty down and pinch soft part of nose
- D. Lie casualty down and pinch top of the nose
Answer: A — Sit casualty down, lean forward and pinch soft part of nose
For a nosebleed, sit the casualty down, lean them forward and pinch the soft part of the nose for about 10 minutes. Leaning forward lets blood drain out of the nose instead of down the throat.
14. An unconscious casualty is lying on their back and has a broken leg, What position is best for the casualty ?
- A. Leave them as they
- B. Sitting up position
- C. Recovery position
- D. Lying down with the legs raised
Answer: C — Recovery position
An unconscious, breathing casualty is placed in the recovery position (modified as needed for the fracture), because a clear airway takes priority over the limb injury.
15. What should a casualty with a severe allergy carry at all times
- A. Insulin
- B. HCQ
- C. Adrenaline
- D. Aspirin
Answer: C — Adrenaline
A person with a known severe allergy should carry an adrenaline (epinephrine) auto-injector at all times. Adrenaline quickly reverses airway swelling and low blood pressure in anaphylaxis until medical help arrives.
16. What is the best method of avoiding accident in workplace ?
- A. By wearing safety equipment
- B. Doing things in one’s own way
- C. By observing safety precautions
- D. Doing things with highly skilled working practice
Answer: C — By observing safety precautions
Observing safety precautions, such as following safe working procedures, permits to work and risk assessments, is the best way to prevent workplace accidents. PPE is the last line of defence and does not replace safe practice.
17. What will be the effect if a person shows the symptoms of drowsiness ?
- A. Activeness
- B. Laziness
- C. Conscious
- D. Unconscious
Answer: D — Unconscious
Drowsiness is a lowered level of consciousness, and if the cause is not corrected the person may become unconscious. A drowsy casualty must be closely watched and their airway protected.
18. Which of the following behaviours reduces your risk for injury ?
- A. Always wearing a safety belt when working
- B. Limiting intake of alcohol
- C. Limiting intake of foods high in cholesterol
- D. Both a and b
Answer: D — Both a and b
Wearing a safety belt or harness when working at height and limiting alcohol intake both directly reduce the risk of injury. A low-cholesterol diet benefits health but does not affect injury risk.
19. A wound where there is damage to the soft tissue and blood vessel under the skin is called ____
- A. A scrape
- B. A cut
- C. A bruise
- D. A avulsion
Answer: C — A bruise
A bruise (contusion) is damage to the soft tissue and blood vessels beneath unbroken skin, causing bleeding under the surface and discolouration. A scrape, cut or avulsion involves breaks in the skin.
20. When giving care or external bleeding, what should you do first ?
- A. Elevate the injury
- B. Apply direct pressure
- C. Apply a loose dressing
- D. Apply a tourniquet
Answer: B — Apply direct pressure
The first step in caring for external bleeding is to apply firm direct pressure over the wound, usually with a sterile dressing. Elevation and other measures follow, and a tourniquet is only for life-threatening limb bleeding.
21. when caring for a victim who has an objective impaled in their hand you should ____
- A. Remove the object, flush with cold water and transport to hospital
- B. Immobilize the object by placing several dressings around it
- C. Break object off where it sticks out, and bandage injury
- D. None of the above
Answer: B — Immobilize the object by placing several dressings around it
An impaled object should not be removed, as it may be plugging the wound. It is stabilised with several bulky dressings placed around it and bandaged in place, and the casualty is taken for medical care.
22. What should you do if someone is unconscious, but you are not a trained first aider?
- A. Get medical help immediately
- B. Try to perform CPR on the crew
- C. Move the crew on to their back
- D. Slap the crew to see if they would wake up
Answer: A — Get medical help immediately
Someone without first aid training who finds an unconscious person should get trained medical help immediately. Calling for help quickly is the most useful action and prevents harm from incorrect treatment.
23. How can you reduce the risk of disease transmission when caring for open bleeding wounds ?
- A. Wash your hands immediately after giving care
- B. Avoid direct contact with the blood
- C. Use protective barriers such as gloves or plastic wrap
- D. All of the above
Answer: D — All of the above
Washing hands after giving care, avoiding direct contact with blood and using barriers such as gloves or plastic wrap all reduce the risk of transmitting disease from open wounds. They should all be used together.
24. The accepted treatment for a femur or thigh fracture is
- A. Place a short padded splint on each side of the leg
- B. This type of fracture is best handled by a traction splint applied by those with special training
- C. Move the victim before properly applying a leg splint
- D. Bind both legs with two long splints using two cravats, one above and one below the break
Answer: B — This type of fracture is best handled by a traction splint applied by those with special training
A femur fracture can cause major blood loss and muscle spasm, so it is best managed with a traction splint applied by people trained in its use. Untrained handling can worsen bleeding and damage.
25. Which of the following is a common treatment for bulimia
- A. Family therapy
- B. Cognitive Behaviour Therapy
- C. Psycodynamic therapy
- D. Humanistic therapy
Answer: B — Cognitive Behaviour Therapy
Cognitive Behaviour Therapy is the most widely used and best-supported treatment for bulimia nervosa, helping the person change the thoughts and behaviours behind the binge-purge cycle.
26. Noro virus can be prevented by the following except
- A. Washing hands often
- B. isolating sick person
- C. Drinking little amount of water
- D. Maintaining strong immune system
Answer: C — Drinking little amount of water
Norovirus is prevented by frequent hand washing, isolating sick persons and keeping the immune system strong. Drinking only a small amount of water does nothing to prevent it, and dehydration is in fact a risk during the illness.
27. How often should you have a Pap smear?
- A. Once a year after puberty
- B. Once a year after either turning 21 or having sexual intercourse for the first time
- C. Once a year after age 21 and twice every year after 30
- D. Once a year if you're not in a monogamous relationship
Answer: B — Once a year after either turning 21 or having sexual intercourse for the first time
Under the older screening guidance, women were advised to begin yearly Pap smears at age 21 or once they became sexually active, whichever came first. Current guidance has since changed to less frequent testing.
28. How often should an adult have a tetanus-diphtheria booster?
- A. 5years
- B. 2years
- C. 10years
- D. 15years
Answer: C — 10years
Adults should receive a tetanus-diphtheria (Td) booster every 10 years to maintain immunity. Seafarers should keep this up to date because cuts and puncture wounds are common on board.
29. The first link in the chain of survival for a casualty in cardiac arrest is:
- A. Transport of the casualty ashore
- B. Early defibrillation
- C. Early recognition of the emergency and calling for help
- D. Post-resuscitation care by a doctor
Answer: C — Early recognition of the emergency and calling for help
The chain of survival starts with early recognition and a call for help, followed by early CPR, early defibrillation and post-resuscitation care. Each link improves survival, but nothing happens until someone recognises the emergency and raises the alarm.
30. The main aims of first aid are often summarised as:
- A. Diagnose the illness, prescribe medicine and discharge the casualty
- B. Move the casualty, record details and inform the company
- C. Give drugs, stitch wounds and arrange evacuation
- D. Preserve life, prevent the condition worsening and promote recovery
Answer: D — Preserve life, prevent the condition worsening and promote recovery
First aid aims to preserve life, prevent deterioration and promote recovery until medical help is available. The elementary first aider is not expected to diagnose or prescribe; that remains with the person in charge of medical care or a doctor.
Set 4 — 30 REFA exit exam questions with answers
1. How many bones are there in the adult human skeleton?
- A. 106
- B. 206
- C. 156
- D. 306
Answer: B — 206
The adult skeleton has 206 bones. They support the body, protect organs such as the brain, heart and lungs, allow movement through joints and muscles, and produce blood cells in the bone marrow.
2. The longest and strongest bone in the human body is the:
- A. Spine
- B. Humerus
- C. Femur
- D. Tibia
Answer: C — Femur
The femur, or thigh bone, is the longest and strongest bone. Because it is surrounded by large muscles and blood vessels, a femoral fracture can cause heavy internal blood loss and shock.
3. How many chambers does the human heart have?
- A. Three
- B. Four
- C. Two
- D. Six
Answer: B — Four
The heart has four chambers: two upper atria that receive blood and two lower ventricles that pump it out. The right side pumps blood to the lungs and the left side pumps oxygenated blood around the body.
4. The normal resting pulse rate of a healthy adult is about:
- A. 120 to 160 beats per minute
- B. 10 to 20 beats per minute
- C. 60 to 100 beats per minute
- D. 30 to 50 beats per minute
Answer: C — 60 to 100 beats per minute
A normal adult resting pulse is roughly 60 to 100 beats per minute. A rapid, weak pulse may indicate shock or blood loss, while a very slow pulse can occur with head injury or hypothermia.
5. The normal breathing rate of an adult at rest is about:
- A. 4 to 8 breaths per minute
- B. 50 to 60 breaths per minute
- C. 30 to 40 breaths per minute
- D. 12 to 20 breaths per minute
Answer: D — 12 to 20 breaths per minute
A resting adult normally breathes about 12 to 20 times per minute. Breathing that is much faster, slower, noisy or irregular should be recorded and reported when seeking medical advice.
6. The normal body temperature of a healthy adult is approximately:
- A. 33 degrees Celsius
- B. 37 degrees Celsius
- C. 39 degrees Celsius
- D. 35 degrees Celsius
Answer: B — 37 degrees Celsius
Normal core body temperature is about 37 degrees Celsius. A core temperature below 35 degrees Celsius indicates hypothermia, while a temperature above about 40 degrees Celsius with hot skin and confusion suggests heat stroke.
7. The largest organ of the human body is the:
- A. Liver
- B. Brain
- C. Skin
- D. Lungs
Answer: C — Skin
The skin is the largest organ. It protects against infection and fluid loss, helps regulate temperature through sweating and blood flow, and contains nerve endings; burns that destroy large areas therefore cause fluid loss and infection risk.
8. Which blood vessels carry oxygenated blood from the lungs back to the heart?
- A. Pulmonary arteries
- B. Coronary veins
- C. Venae cavae
- D. Pulmonary veins
Answer: D — Pulmonary veins
The pulmonary veins are the only veins that carry oxygen-rich blood, returning it from the lungs to the left atrium. The left ventricle then pumps it to the body through the aorta.
9. In the lungs, oxygen passes into the blood through the walls of tiny air sacs called:
- A. Villi
- B. Alveoli
- C. Bronchi
- D. Ventricles
Answer: B — Alveoli
The alveoli are tiny air sacs at the end of the airways, surrounded by capillaries. Oxygen diffuses into the blood and carbon dioxide passes out of it across their thin walls.
10. Muscles are attached to bones by:
- A. Nerves
- B. Ligaments
- C. Cartilage
- D. Tendons
Answer: D — Tendons
Tendons are tough cords that attach muscles to bones so that muscle contraction moves the joint. Ligaments, by contrast, join bone to bone; overstretching them causes a sprain.
11. The flap of tissue that closes over the windpipe during swallowing to stop food entering the airway is the:
- A. Oesophagus
- B. Diaphragm
- C. Epiglottis
- D. Tonsil
Answer: C — Epiglottis
The epiglottis covers the entrance to the larynx and trachea when swallowing. In an unconscious casualty protective reflexes are lost, so vomit or fluids can enter the airway, which is why the recovery position is used.
12. The total volume of blood in an average adult is about:
- A. 1 to 2 litres
- B. 15 to 20 litres
- C. 5 to 6 litres
- D. 10 to 12 litres
Answer: C — 5 to 6 litres
An average adult has about 5 to 6 litres of blood. Losing a significant part of this volume, externally or internally, reduces circulating volume and leads to hypovolaemic shock.
13. The main purpose of the recovery position for an unconscious casualty who is breathing is to:
- A. Increase blood flow to the legs
- B. Prevent the casualty from feeling pain
- C. Make it easier to perform chest compressions
- D. Keep the airway open and allow vomit or fluid to drain from the mouth
Answer: D — Keep the airway open and allow vomit or fluid to drain from the mouth
An unconscious casualty may lose airway reflexes and the tongue can fall back. The recovery position keeps the airway open with the head tilted and lets vomit or fluid drain out of the mouth instead of being inhaled.
14. A casualty in shock with no leg, hip or spinal injury should be laid down:
- A. On his back with the legs raised and supported above the level of the heart
- B. Sitting upright in a chair
- C. Face down with the arms by his sides
- D. On his back with the head raised on pillows
Answer: A — On his back with the legs raised and supported above the level of the heart
Laying a shocked casualty down and raising the legs helps return blood to the vital organs. Leg raising is avoided when there is a suspected fracture of the legs, pelvis or spine.
15. A conscious casualty has a wound running across the abdomen. To prevent the wound gaping, he should be laid:
- A. On his back with the knees bent and supported
- B. Sitting upright with the legs straight
- C. Flat with the legs straight and raised
- D. Face down
Answer: A — On his back with the knees bent and supported
Bending and supporting the knees relaxes the abdominal muscles and reduces strain on a wound running across the abdomen, helping to stop it opening and reducing pain while the wound is covered and help is called.
16. An unconscious, breathing casualty has a chest injury on one side. In the recovery position he should be placed:
- A. On his back with legs raised
- B. With the injured side down
- C. With the injured side up
- D. Face down
Answer: B — With the injured side down
Lying with the injured side down supports the injured chest wall and allows the uninjured lung to expand freely, while the recovery position keeps the airway clear.
17. A conscious casualty with burns to the face and possible inhalation injury is best positioned:
- A. Lying face down on a stretcher
- B. Sitting up to make breathing easier
- C. In the recovery position with the face down
- D. Lying flat with the legs raised
Answer: B — Sitting up to make breathing easier
Burns to the face and airway can cause swelling and breathing difficulty. A sitting position makes breathing easier; the casualty must be monitored closely and urgent medical advice sought.
18. You are alone with an unconscious casualty who is breathing normally and you must leave to get help. Before leaving you should:
- A. Give him a drink of water
- B. Leave him lying flat on his back
- C. Sit him up against a bulkhead
- D. Place the casualty in the recovery position
Answer: D — Place the casualty in the recovery position
An unconscious casualty left on his back may have his airway blocked by the tongue or vomit. Placing him in the recovery position keeps the airway open while you go for help.
19. A conscious casualty with a penetrating eye injury should be positioned:
- A. Lying on his back with the head supported and kept still
- B. Face down to let the eye drain
- C. Sitting with the head bent forward between the knees
- D. Standing and walking to the hospital
Answer: A — Lying on his back with the head supported and kept still
Lying on the back with the head supported reduces movement and pressure on the eye. Both eyes may be covered to stop eye movement, and the object must not be removed.
20. An unconscious casualty with no suspected spinal injury who is breathing normally is best carried on a stretcher:
- A. Flat on his back with the head tilted forward
- B. In the recovery position, so the airway stays clear
- C. Face down with the arms under the body
- D. Sitting upright and strapped in
Answer: B — In the recovery position, so the airway stays clear
Transporting an unconscious, breathing casualty in the recovery position protects the airway from the tongue and vomit. He must be secured to the stretcher and his breathing checked throughout the move.
21. When opening the airway of an unconscious casualty with a suspected neck injury, the preferred method is the:
- A. Turning the head sharply to one side
- B. Head tilt with neck lift
- C. Abdominal thrust
- D. Jaw thrust without head tilt
Answer: D — Jaw thrust without head tilt
A jaw thrust lifts the lower jaw forward to clear the tongue from the airway while keeping the head and neck still. If the airway still cannot be opened, careful head tilt is used because breathing takes priority.
22. After opening the airway of an unresponsive casualty, normal breathing should be checked by looking, listening and feeling for no more than:
- A. 1 minute
- B. 10 seconds
- C. 2 minutes
- D. 30 seconds
Answer: B — 10 seconds
Resuscitation guidelines advise checking for normal breathing for no more than 10 seconds. If the casualty is not breathing normally, or you are unsure, call for help and start CPR without delay.
23. An unconscious casualty should never be given anything by mouth because:
- A. It will delay digestion
- B. It may enter the airway and cause choking
- C. It will make the casualty more thirsty
- D. It may raise the blood pressure too much
Answer: B — It may enter the airway and cause choking
An unconscious casualty cannot swallow or protect his airway. Food, drink or tablets may pass into the windpipe and lungs, causing choking or aspiration, so nothing is given by mouth.
24. In adult CPR, chest compressions should be given at a rate of:
- A. 30 to 40 per minute
- B. 60 to 80 per minute
- C. 140 to 160 per minute
- D. 100 to 120 per minute
Answer: D — 100 to 120 per minute
Current ILCOR-based guidelines recommend chest compressions at 100 to 120 per minute, with full recoil after each compression and minimal interruptions, to maintain blood flow to the brain and heart.
25. In adult CPR, the breastbone should be pressed down by about:
- A. 5 to 6 cm
- B. 1 to 2 cm
- C. Half the depth of the chest
- D. 8 to 10 cm
Answer: A — 5 to 6 cm
Compressions on the lower half of the breastbone should depress it by about 5 to 6 cm in an adult. Shallower compressions produce too little blood flow, while excessive depth increases the risk of injury.
26. When an AED is analysing the heart rhythm or delivering a shock, the rescuers must:
- A. Ensure nobody is touching the casualty
- B. Continue chest compressions
- C. Remove the pads from the chest
- D. Give rescue breaths
Answer: A — Ensure nobody is touching the casualty
Movement and contact can disturb the rhythm analysis, and anyone touching the casualty during a shock could receive it. Rescuers stand clear when prompted, then resume CPR immediately after the shock.
27. Immediately after an AED has delivered a shock, the rescuer should:
- A. Remove the pads and place the casualty in the recovery position
- B. Check the pulse for one minute before doing anything
- C. Wait for the AED to deliver a second shock
- D. Resume CPR at once, starting with chest compressions, and follow the AED prompts
Answer: D — Resume CPR at once, starting with chest compressions, and follow the AED prompts
After a shock the heart rarely pumps effectively at once. Guidelines direct immediate resumption of CPR starting with compressions, while the AED reanalyses the rhythm after about two minutes and gives further prompts.
28. A conscious infant is choking and five back blows have failed to clear the obstruction. The next step is to give up to five:
- A. Abdominal thrusts
- B. Chest thrusts
- C. Rescue breaths
- D. Finger sweeps of the mouth
Answer: B — Chest thrusts
For infants under one year, abdominal thrusts are not used because of the risk of injury to abdominal organs. Up to five back blows are followed by up to five chest thrusts, repeated while the infant remains conscious.
29. When a tourniquet has been applied to control life-threatening bleeding from a limb, the first aider must:
- A. Remove it as soon as the bleeding stops
- B. Loosen it every five minutes to let blood through
- C. Cover it with clothing so that the casualty is not alarmed
- D. Note the time of application and make sure it is reported to medical help
Answer: D — Note the time of application and make sure it is reported to medical help
A tourniquet is reserved for life-threatening limb bleeding not controlled by direct pressure. The time of application must be recorded and passed on, and it should not be loosened or removed by the first aider.
30. Bleeding that is bright red and spurts in time with the heartbeat is most likely:
- A. Arterial bleeding
- B. Capillary bleeding
- C. Venous bleeding
- D. Internal bleeding
Answer: A — Arterial bleeding
Arteries carry oxygenated blood under pressure from the heart, so arterial bleeding is bright red and spurts with each heartbeat. It can quickly become life-threatening and needs firm direct pressure at once.
Set 5 — 35 REFA exit exam questions with answers
1. In a casualty developing shock, the pulse is typically:
- A. Absent from the start
- B. Slow and strong
- C. Rapid and becoming weaker
- D. Normal and regular
Answer: C — Rapid and becoming weaker
As circulating volume falls, the heart beats faster to maintain blood pressure, so the pulse becomes rapid and then weak or thready. Pulse rate should be checked and recorded regularly.
2. The skin of a casualty in shock is usually:
- A. Red, hot and dry
- B. Blue only on the lips but warm
- C. Pale, cold and clammy
- D. Flushed and warm
Answer: C — Pale, cold and clammy
In shock, blood is diverted from the skin to the vital organs, so the skin becomes pale or grey, cold and clammy with sweating. Lips may turn blue-grey as the condition worsens.
3. Shock caused by a loss of blood or body fluids, for example from severe bleeding, burns or vomiting, is called:
- A. Cardiogenic shock
- B. Neurogenic shock
- C. Hypovolaemic shock
- D. Anaphylactic shock
Answer: C — Hypovolaemic shock
Hypovolaemic shock results from a reduced volume of circulating blood or fluid. Common causes include external or internal bleeding, plasma loss from burns and fluid loss from severe vomiting or diarrhoea.
4. Shock caused by a severe infection spreading through the bloodstream is called:
- A. Hypovolaemic shock
- B. Electrical shock
- C. Septic shock
- D. Cardiogenic shock
Answer: C — Septic shock
In septic shock, toxins from a severe infection cause blood vessels to dilate and leak, so blood pressure falls. It is a medical emergency needing urgent medical advice and evacuation where possible.
5. A casualty in anaphylactic shock has been given one adrenaline auto-injector but has not improved after about five minutes. The first aider should:
- A. Give a second auto-injector if one is available
- B. Give the casualty a hot drink
- C. Wait at least one hour before giving another
- D. Make the casualty walk about to improve circulation
Answer: A — Give a second auto-injector if one is available
Anaphylaxis guidance advises a further dose of adrenaline after about five minutes if symptoms persist or worsen, using a second auto-injector, while continuing to seek urgent medical help and monitoring breathing.
6. Which of the following signs suggests anaphylaxis after an insect sting or eating a food?
- A. Pain only at the sting site with slight redness
- B. Slow pulse and hot, dry skin
- C. Shivering and loss of coordination
- D. Swelling of the face, lips and tongue with wheezing and difficulty breathing
Answer: D — Swelling of the face, lips and tongue with wheezing and difficulty breathing
Anaphylaxis is a severe allergic reaction affecting the airway, breathing and circulation. Swelling of the face, tongue and throat, wheezing, a widespread rash and signs of shock require adrenaline and urgent medical help.
7. A full-thickness burn may be less painful than a superficial burn because:
- A. The nerve endings in the skin have been destroyed
- B. The burn has already healed
- C. Full-thickness burns do not damage the skin
- D. The casualty is always unconscious
Answer: A — The nerve endings in the skin have been destroyed
Full-thickness burns destroy all layers of the skin, including the nerve endings, so the area may look white, waxy or charred and feel painless. It is a serious burn needing medical attention despite the lack of pain.
8. When estimating the extent of a small or scattered burn, the area of the casualty's own palm and fingers represents about what percentage of the body surface?
- A. 1%
- B. 9%
- C. 18%
- D. 5%
Answer: A — 1%
The casualty's palm including the fingers is about 1 percent of the body surface area. It is a quick way to estimate small or patchy burns, while the rule of nines is used for larger areas.
9. A crew member has a chemical splashed on the skin. After removing contaminated clothing, the area should be flushed with plenty of cool running water for at least:
- A. 20 minutes
- B. 3 minutes
- C. 1 minute
- D. 5 minutes
Answer: A — 20 minutes
Chemical burns continue as long as the chemical remains on the skin, so prolonged flushing for at least 20 minutes is advised. The first aider should wear gloves and avoid contaminating himself, and refer to the SDS or MFAG.
10. When irrigating an eye splashed with chemical, the casualty's head should be tilted so that:
- A. The face is pointing directly downward into a basin
- B. The head is tilted back with both eyes facing up
- C. The injured eye is lowermost, so water runs away from the uninjured eye
- D. The uninjured eye is lowermost
Answer: C — The injured eye is lowermost, so water runs away from the uninjured eye
Tilting the head with the injured eye lowermost lets the contaminated water flow away from the face and the good eye. Irrigation should continue for at least 10 to 20 minutes with the eyelids held open.
11. A crew member is in contact with a low-voltage electrical supply and the switch cannot be reached. The first aider should:
- A. Use a metal bar to lever the cable away
- B. Throw water over the casualty
- C. Stand on dry insulating material and push the casualty's limb away with a dry wooden object
- D. Pull the casualty away by the bare hand
Answer: C — Stand on dry insulating material and push the casualty's limb away with a dry wooden object
If the supply cannot be isolated, the rescuer insulates himself by standing on a dry book, rubber mat or wood and uses a dry non-conducting object such as a wooden broom handle to separate the casualty from the source.
12. Blisters that form over a burn should be:
- A. Cut away and treated with ointment
- B. Rubbed with ice until they disappear
- C. Left intact and covered with a clean, non-fluffy dressing
- D. Burst with a clean needle to relieve pressure
Answer: C — Left intact and covered with a clean, non-fluffy dressing
Blisters protect the damaged skin underneath from infection. Bursting them opens the wound to contamination, so they are left intact and covered loosely with a sterile or clean non-fluffy dressing.
13. The main advantage of the Neil Robertson stretcher on board ship is that it:
- A. Holds the casualty rigidly so he can be lifted vertically through hatches and narrow spaces
- B. Is made entirely of metal mesh for helicopter use
- C. Folds into a chair for walking casualties
- D. Can be inflated to float on water
Answer: A — Holds the casualty rigidly so he can be lifted vertically through hatches and narrow spaces
The Neil Robertson stretcher wraps and splints the casualty firmly with straps, so he can be hoisted vertically or manoeuvred horizontally through hatches, engine room passages and other confined spaces without slipping.
14. The pick-a-back carry is suitable for a casualty who:
- A. Has a suspected spinal injury
- B. Is unconscious
- C. Has fractured arms
- D. Is conscious and able to hold on to the rescuer
Answer: D — Is conscious and able to hold on to the rescuer
In the pick-a-back carry the casualty is carried on the rescuer's back and must be conscious and able to hold on with his arms. It is unsuitable for unconscious casualties or those with arm, chest or spinal injuries.
15. Before anyone enters an enclosed space without breathing apparatus, the oxygen content of the atmosphere should read:
- A. 21% by volume
- B. 16% by volume
- C. 30% by volume
- D. 12% by volume
Answer: A — 21% by volume
IMO recommendations for entering enclosed spaces call for a steady oxygen reading of 21 percent by volume, with flammable and toxic gases tested and within limits. Lower readings indicate a dangerous oxygen-deficient atmosphere.
16. A casualty with a suspected spinal injury should be moved by the first aider only when:
- A. The deck needs to be cleared for work
- B. There is immediate danger to life, such as fire or toxic gas
- C. He is waiting for the doctor
- D. He complains of being uncomfortable
Answer: B — There is immediate danger to life, such as fire or toxic gas
Moving a spinal casualty can cause permanent damage to the spinal cord. He is kept still with the head supported in line unless there is an immediate threat to life or the airway cannot otherwise be maintained.
17. During an enclosed space rescue, the attendant stationed at the entrance should:
- A. Keep in contact with those inside, raise the alarm and not enter until properly equipped and relieved
- B. Enter at once to help the collapsed person
- C. Leave the entrance to fetch equipment
- D. Close the entrance to keep out the weather
Answer: A — Keep in contact with those inside, raise the alarm and not enter until properly equipped and relieved
The attendant maintains communication with entrants and raises the alarm in an emergency. Many enclosed space deaths are of unprotected would-be rescuers, so the attendant must not enter without breathing apparatus and backup.
18. An incomplete fracture in which a young, flexible bone bends and cracks on one side only is called a:
- A. Greenstick fracture
- B. Open fracture
- C. Comminuted fracture
- D. Impacted fracture
Answer: A — Greenstick fracture
A greenstick fracture occurs mainly in children, whose bones are flexible; the bone bends and cracks partly through, like a green twig. It is treated by supporting and immobilising the limb as for any fracture.
19. A casualty has swallowed a corrosive chemical. The first aider should:
- A. Give the casualty an alcoholic drink
- B. Give salt water to drink
- C. Make the casualty vomit at once
- D. Not induce vomiting, rinse the mouth and seek medical advice urgently
Answer: D — Not induce vomiting, rinse the mouth and seek medical advice urgently
Vomiting a corrosive substance burns the gullet, mouth and airway a second time. The first aider keeps the airway open, does not induce vomiting, may give small sips of water if conscious and obtains medical advice.
20. When a casualty has swallowed a poison, which of the following will most help the medical adviser?
- A. The colour of the casualty's clothing
- B. The weather at the time
- C. The casualty's rank
- D. The container or a sample of the substance, and the amount and time taken
Answer: D — The container or a sample of the substance, and the amount and time taken
Identifying the substance, the quantity and when it was taken allows the medical adviser to judge its effects and treatment. Containers, labels, SDS sheets or samples of vomit should be kept with the casualty.
21. Hydrogen sulphide is particularly dangerous because at higher concentrations it:
- A. Is only harmful when swallowed
- B. Quickly paralyses the sense of smell, so the gas can no longer be detected
- C. Turns the skin bright yellow
- D. Smells strongly of almonds that warns everyone
Answer: B — Quickly paralyses the sense of smell, so the gas can no longer be detected
Hydrogen sulphide has a rotten-egg odour at low concentrations, but higher concentrations rapidly deaden the sense of smell. Smell must never be relied upon; gas detectors and breathing apparatus are used.
22. Carbon monoxide is poisonous mainly because it:
- A. Blocks the stomach
- B. Causes the bones to soften
- C. Burns the skin on contact
- D. Combines with haemoglobin and prevents the blood from carrying oxygen
Answer: D — Combines with haemoglobin and prevents the blood from carrying oxygen
Carbon monoxide binds to haemoglobin far more readily than oxygen, so the blood carries less oxygen to the tissues. Casualties are removed to fresh air by rescuers wearing breathing apparatus and given oxygen if available.
23. A bee sting is left embedded in the skin. It is best removed by:
- A. Squeezing it out between the fingers
- B. Pulling it out with tweezers by gripping the venom sac
- C. Leaving it in place until a doctor arrives
- D. Scraping it off sideways with a fingernail or the edge of a card
Answer: D — Scraping it off sideways with a fingernail or the edge of a card
Squeezing the sting or its venom sac can inject more venom. Scraping it sideways with a blunt edge removes it cleanly; then apply a cold compress and watch for signs of an allergic reaction.
24. A crew member swimming from the ship is stung by a jellyfish. The affected area should be rinsed with:
- A. Alcohol
- B. Hot oil
- C. Fresh water
- D. Sea water
Answer: D — Sea water
Fresh water can make remaining stinging cells discharge more venom, so the area is rinsed with sea water and any tentacles lifted off carefully. Pain may be relieved by heat or cold, and anaphylaxis should be watched for.
25. A hypothermic casualty who is conscious should be rewarmed by:
- A. Rubbing the arms and legs vigorously
- B. Giving alcohol to warm him quickly
- C. Making him run around the deck
- D. Removing wet clothing, insulating him in dry blankets and giving warm sweet drinks
Answer: D — Removing wet clothing, insulating him in dry blankets and giving warm sweet drinks
Rewarming should be gradual: shelter, replace wet clothes, insulate including the head, and give warm sweet drinks if he can swallow. Alcohol dilates surface vessels and increases heat loss, and rubbing can be harmful.
26. In a casualty with worsening hypothermia, which sign indicates that the condition has become severe?
- A. Shivering stops while the casualty becomes drowsy or confused
- B. Goose pimples appear on the skin
- C. The casualty complains of feeling cold
- D. Shivering starts
Answer: A — Shivering stops while the casualty becomes drowsy or confused
Shivering is the body's way of generating heat in mild hypothermia. When the core temperature falls further, shivering ceases and the casualty becomes confused, drowsy and eventually unconscious, with risk of cardiac arrest.
27. Frostbitten fingers should NOT be:
- A. Rubbed, because this damages the frozen tissues
- B. Warmed slowly in the casualty's armpits
- C. Handled gently
- D. Protected from further cold
Answer: A — Rubbed, because this damages the frozen tissues
Frozen tissues are fragile, and rubbing them causes further damage. Frostbite is rewarmed gently, for example in the armpits or warm water, only when there is no risk of refreezing, and medical advice is obtained.
28. A crew member working in the engine room is confused, with hot, flushed, dry skin and a very high body temperature. The priority is to:
- A. Wrap him in blankets
- B. Give him hot drinks
- C. Move him to a cool place and cool him rapidly, for example with wet cloths and fanning
- D. Make him continue working slowly
Answer: C — Move him to a cool place and cool him rapidly, for example with wet cloths and fanning
These signs suggest heat stroke, a life-threatening failure of the body's temperature control. Rapid cooling by moving to a cool place, removing clothing, applying cold wet cloths and fanning is essential while medical advice is obtained.
29. Painful muscle cramps after heavy work in a hot environment are mainly due to:
- A. Loss of salt and water through sweating
- B. Lack of sleep
- C. Too much salt in the diet
- D. A broken bone
Answer: A — Loss of salt and water through sweating
Heat cramps occur when heavy sweating causes loss of salt and fluid. The casualty should rest in a cool place, gently stretch the muscle and drink water or an oral rehydration solution.
30. In the FAST test used to recognise a stroke, the letter T stands for:
- A. Tongue
- B. Time to call for medical help
- C. Temperature
- D. Tremor
Answer: B — Time to call for medical help
FAST stands for Face, Arms, Speech and Time. If the face droops, an arm is weak or speech is slurred, it is time to seek emergency medical help at once, because early treatment reduces brain damage.
31. A conscious crew member with a known diabetic condition becomes shaky, sweaty and confused, suggesting a low blood sugar. The first aider should:
- A. Give nothing and let him sleep it off
- B. Give him a large meal of fatty food
- C. Give a sugary drink or glucose tablets if he can swallow
- D. Give him an injection of insulin
Answer: C — Give a sugary drink or glucose tablets if he can swallow
In hypoglycaemia, quickly absorbed sugar such as glucose tablets, fruit juice or a sugary drink usually brings rapid improvement. Nothing is given by mouth if he is drowsy or unconscious; seek medical advice.
32. Chest pain that comes on during exertion and eases within a few minutes of rest is typical of:
- A. A fractured rib
- B. Angina
- C. A heart attack
- D. A stroke
Answer: B — Angina
Angina pain is caused by narrowed coronary arteries and is relieved by rest and the casualty's own medication. In a heart attack, the pain usually persists despite rest and needs urgent medical help.
33. For a conscious adult with suspected heart attack who is not allergic to it, first aid guidelines recommend:
- A. A glass of brandy
- B. Two paracetamol tablets swallowed with water
- C. Nothing at all until a doctor arrives
- D. One 300 mg aspirin tablet to be chewed slowly
Answer: D — One 300 mg aspirin tablet to be chewed slowly
Aspirin helps limit clotting in the coronary arteries. First aid guidance advises 300 mg chewed slowly if the casualty is not allergic, while keeping him at rest, half-sitting, and obtaining urgent medical advice.
34. A crew member is having an asthma attack. The first aider should:
- A. Give him a hot meal
- B. Help him sit upright, leaning slightly forward, and use his reliever inhaler
- C. Make him breathe into a paper bag
- D. Lay him flat on his back
Answer: B — Help him sit upright, leaning slightly forward, and use his reliever inhaler
Sitting upright and slightly forward makes breathing easier. The casualty's reliever inhaler, usually blue, opens the airways; if the attack does not improve or becomes severe, urgent medical help is needed.
35. During an epileptic seizure, the first aider should:
- A. Hold the casualty down firmly to stop the movements
- B. Protect the casualty from injury, cushion the head and not restrain him or put anything in his mouth
- C. Throw cold water on the face
- D. Force a spoon between the teeth
Answer: B — Protect the casualty from injury, cushion the head and not restrain him or put anything in his mouth
Restraint can injure the casualty, and objects in the mouth can break teeth or block the airway. Clear the area, protect the head, time the seizure and place in the recovery position when the jerking stops.
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