Which patient should not receive mitotane as ordered?

Mitotane is an adrenocortical agent used primarily in the treatment of adrenocortical carcinoma, as it helps to reduce cortisol production by the adrenal glands. When considering which patient should not receive mitotane, it is essential to evaluate the patient's overall clinical condition and the potential risks associated with the medication.

Administering mitotane to a patient experiencing shock can be particularly dangerous. Shock, regardless of its etiology, indicates a state of inadequate perfusion and can lead to severe consequences if not promptly treated. Mitotane can cause adrenal insufficiency due to its cortisol-reducing effects, which in turn can exacerbate the patient's hemodynamic instability. This could put the patient further at risk of complications since shock requires immediate stabilization and treatment—typically not the initiation of a therapy that could lead to further adrenal compromise.

In contrast, the other options involve patients who, while they may exhibit concerning symptoms or conditions, are not in an immediate life-threatening state such as shock. For instance, a patient with a heart rate of 100 beats per minute might be experiencing tachycardia but not in an acute crisis where they cannot tolerate new medications. Similarly, a patient diagnosed with adrenocarcinoma is the