Select all the signs and symptoms below that can present in myasthenia gravis.

Choice A rationale Myasthenia gravis is an autoimmune disorder where antibodies block acetylcholine receptors at the neuromuscular junction, impairing muscle contraction. It typically does not cause increased salivation; instead, difficulty swallowing (dysphagia) may lead to drooling, but the disease itself is not a primary cause of hypersecretion. Choice B rationale Diplopia, or double vision, is a common early sign of myasthenia gravis, resulting from the weakness of the extraocular muscles responsible for eye movement. This muscle weakness is intermittent and worsens with repetitive use or at the end of the day due to decreased acetylcholine receptor function. Choice C rationale Ptosis, or drooping of one or both eyelids, is caused by the weakness of the levator palpebrae superioris muscle. It is a highly characteristic and often initial symptom of myasthenia gravis, also fluctuating in severity and worsening with fatigue. Choice D rationale Slurred speech (dysarthria) occurs due to weakness of the muscles involved in articulation, including the tongue, pharynx, and larynx. This symptom is common in myasthenia gravis, making the client's voice sound soft, nasal, or fatigued after speaking for a period. Choice E rationale Restlessness is not a typical sign of myasthenia gravis; the client's mental status is usually unimpaired. Restlessness could potentially indicate hypoxemia or anxiety, which are complications but not primary symptoms of the underlying neuromuscular disease process. Choice F rationale Respiratory failure is a severe, life-threatening complication in myasthenic crisis, caused by weakness of the diaphragm and intercostal muscles that are essential for breathing. This requires immediate intervention and ventilator support to prevent further respiratory compromise. Choice G rationale A mask-like appearance of looking sleepy is a common description, caused by weakness of the facial muscles (e.g., orbicularis oculi, zygomaticus). This results in a flattened, expressionless face that contributes to the characteristic presentation of the disease. Choice H rationale Difficulty swallowing (dysphagia) is common due to weakness of the pharyngeal and laryngeal muscles. This symptom increases the risk of aspiration and is a major concern, often fluctuating and worsening when the client is fatigued or during meals.