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REFA exit exam questions and answers — Set 5 — Refresher Elementary First Aid

Set 5 of the Refresher Elementary First Aid (REFA) exit exam bank — 35 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 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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