Which patient should not receive mitotane as ordered?

Mitotane is primarily used in the treatment of adrenocortical carcinoma by suppressing adrenal corticosteroid production. One of the critical factors to consider before administering mitotane is the patient's overall stability, particularly their hemodynamic status. A patient experiencing shock is in a critical condition where organ perfusion is compromised, and the administration of mitotane could worsen their condition by further destabilizing their metabolic status or leading to adrenal crises due to its effect on the adrenal glands.

In such scenarios, the risks associated with starting a medication like mitotane, which has profound effects on hormonal balance and requires careful monitoring of the patient’s condition, outweigh the potential benefits. It is vital to stabilize a patient experiencing shock before introducing new treatments, particularly those that may influence the endocrine system. Thus, this patient's immediate medical condition makes mitotane an inappropriate choice at that time.