A nurse is reinforcing teaching with a client who is lactose intolerant. Which of the following statements should the nurse include in the teaching?

Choice A rationale Increasing fiber intake is generally beneficial for digestive health, but it does not address the underlying pathophysiology of lactose intolerance. Lactose intolerance is caused by a deficiency in the enzyme lactase, which is necessary to break down the disaccharide lactose into glucose and galactose. While fiber helps with regular bowel movements, it will not prevent the gas, bloating, and osmotic diarrhea that occur when undigested lactose remains in the intestinal tract and undergoes bacterial fermentation. Choice B rationale Clients who are lactose intolerant are actually at a higher risk for vitamin D and calcium deficiencies because they often avoid dairy, which is a primary source of these nutrients. Therefore, decreasing vitamin D in the diet would be contraindicated and potentially harmful. These clients should be encouraged to find alternative sources of vitamin D, such as fortified non-dairy milks, egg yolks, or sunlight exposure, to maintain bone health and prevent conditions like osteoporosis or osteomalacia. Choice C rationale This is the most important dietary modification because lactose is the sugar found in milk and milk-derived products. Reducing or eliminating these items prevents the gastrointestinal symptoms associated with the inability to digest lactose. The nurse should educate the client on identifying hidden sources of lactose and suggest alternatives like lactose-free milk or enzyme replacement drops. Normal digestion requires lactase, and without it, the osmotic draw of undigested sugar causes significant abdominal distress and diarrhea. Choice D rationale Increasing total caloric intake is not a specific requirement for managing lactose intolerance unless the client has experienced significant weight loss due to malabsorption. The focus of nutritional counseling should be on ensuring a balanced diet that excludes the offending substance while replacing essential nutrients commonly found in dairy. Simply increasing calories does not mitigate the symptoms of the intolerance and could lead to unnecessary weight gain if the diet is not carefully planned around the client's specific needs.