The national university entrance exam in Iran, serving as a decisive test, generates widespread psychological consequences for candidates and their families, having evolved in recent years into a major mental health issue for adolescents and youth. The paradigm of "one test, one estimation, one destiny," by inefficiently occupying psychological and educational capacities, not only increases competition and anxiety but also deflects formal education from deep learning toward test-oriented instruction, thereby undermining students' motivation and interest in the learning process. Pre-exam pressures are accompanied by anxiety reactions, tension, and panic, alongside consequences such as familial disturbances, physical problems, and social crises; whereas post-exam, reactions such as depression, a sense of failure, self-distrust, and even tendencies toward suicide may emerge. Furthermore, the proliferation of exam-prep centers and non-specialized counseling has intensified heavy costs and candidate confusion, threatening their psychological security. Proposed strategies emphasize reducing stressors through quality control of question design, teaching stress management and emotional regulation skills to candidates, educating families to alleviate psychological pressure, improving the physical and traffic conditions of exam centers, training exam proctors to correctly handle emergency situations, the national media's role in mental health education, and the establishment of specialized and reputable counseling centers for candidates.