What sign indicates an adverse effect in a client with myasthenia gravis taking neostigmine?

In the context of myasthenia gravis, neostigmine is a medication that acts as an indirect-acting cholinergic agent by inhibiting the enzyme acetylcholinesterase, which results in increased levels of acetylcholine at the neuromuscular junction. While this can help improve muscle strength in individuals with myasthenia gravis, it also carries the risk of side effects, particularly those related to overstimulation of the cholinergic system.

Miosis, or constricted pupils, is a classic adverse effect associated with cholinergic medications, including neostigmine. When acetylcholine levels are increased, this can lead to excessive stimulation of the muscarinic receptors in the eye, causing the pupils to constrict. This sign serves as an important indicator that the client may be experiencing an adverse effect due to excessive cholinergic stimulation, requiring careful monitoring and possibly dosage adjustment of the neostigmine.

In contrast, tachycardia is usually associated with anticholinergic effects rather than cholinergic medication. Xerostomia, or dry mouth, is more common with anticholinergic drugs and not typically associated with neostigmine. Oliguria, or decreased urine output,