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REFA exit exam questions and answers — Set 4 — Refresher Elementary First Aid

Set 4 of the Refresher Elementary First Aid (REFA) exit exam bank — 30 of 155 questions, 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 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.

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