A nurse is planning to teach an adolescent who is lactose intolerant about dietary guidelines. Which of the following instructions should the nurse include in the teaching?

Lactose intolerance occurs due to deficiency of the enzyme lactase, leading to gastrointestinal symptoms such as bloating, abdominal cramps, and diarrhea after ingestion of lactose-containing foods. Adolescents with this condition need dietary modifications to ensure adequate calcium and vitamin D intake for bone health while avoiding or limiting lactose-containing products. Teaching focuses on identifying safe alternatives that maintain nutritional adequacy without triggering symptoms. Rationale: A. Although yogurt is often better tolerated than milk because the active cultures (bacteria) help digest the lactose, flavoring does not inherently reduce lactose content. In fact, some flavored yogurts contain additives or higher sugar content that could exacerbate osmotic diarrhea. The tolerance for yogurt is based on the presence of live cultures, not the flavoring. B. Replacing milk with nondairy sources of calcium is correct because it ensures adequate calcium intake without exposure to lactose. Options such as fortified plant-based milks, leafy greens, tofu, and fortified juices support bone health while preventing gastrointestinal symptoms. This reflects appropriate dietary management for lactose intolerance. C. Drinking milk on an empty stomach is incorrect because lactose intolerance symptoms are related to enzyme deficiency, not stomach fullness. Whether milk is consumed with or without food does not prevent lactose from causing gastrointestinal symptoms. This approach would not reduce intolerance-related effects. D. Tolerating plain milk better than chocolate milk is incorrect because both contain lactose, and chocolate milk may actually be slightly better tolerated in some cases due to added fat and reduced lactose concentration per volume, but neither is reliably tolerated. Lactose content, not flavoring, determines tolerance.