In managing a patient with myasthenia gravis being treated with pyridostigmine, which of the following should the nurse assess for effectiveness of the treatment? Select all that apply.

Rationale: A. Gastrointestinal upset is a common side effect of pyridostigmine, not an indicator of treatment effectiveness. While monitoring for adverse effects is important, diarrhea does not reflect whether the medication is improving muscle function. B. Pyridostigmine enhances neuromuscular transmission, leading to reduced muscle fatigue. A patient reporting less fatigue during daily activities indicates the medication is working effectively. C. Injection site discomfort is not related to the efficacy of pyridostigmine; it is a local adverse effect. Monitoring for pain is important for patient comfort, but it does not indicate treatment success. D. Ptosis, dysarthria, and difficulty speaking are common symptoms in myasthenia gravis due to weak facial and respiratory muscles. Improvement in speech endurance reflects enhanced neuromuscular function, signaling effective therapy. E. Pyridostigmine increases acetylcholine availability at the neuromuscular junction, improving skeletal muscle strength. Observable improvements in mobility or exercise tolerance indicate treatment effectiveness. F. Respiratory muscles may be affected in myasthenia gravis, and pyridostigmine can enhance respiratory muscle strength, reducing dyspnea or respiratory compromise. This is a critical indicator of therapeutic effectiveness, especially to prevent myasthenic crisis. G. While pyridostigmine can cause cholinergic side effects such as bradycardia, changes in heart rate are not an indicator of effectiveness. Heart rate monitoring is for safety and side effect management, not therapeutic assessment.