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.

Presence of gastrointestinal upset such as diarrhea

Decreased fatigue levels reported by the patient

Client's report of discomfort around the injection site

Increased ability to tolerate prolonged speaking without fatigue

Improvement in muscle strength during physical activity

Reduction in respiratory distress or difficulty breathing

Increase in heart rate