This study aims to investigate middle school mathematics teachers’ opinions about PISA-like skill-based mathematics questions, ways of implementing these questions during their in-class practices, and needs for a professional support. Adopting a mixed-method approach, at first, we collected the qualitative data through semi-structured interviews with 10 middle school mathematics teachers. Later, a questionnaire was developed depending on the qualitative data, and by using a survey method we collected the quantitative data from 217 middle school mathematics teachers working in Istanbul. The qualitative and quantitative data show that teachers have positive ideas about the nature of the skill-based mathematics questions. The frequency of using these questions in mathematics classes increases by the eighth grade and teachers generally use these questions once a week. Teachers’ ways of implementing these questions in mathematics classes appears generally as giving homework and checking, classroom discussion, and privately solving the questions coming from students. Although teachers’ ways of implementing these questions have some differentiations according to school types, but this differentiation is not statistically significant. Most of the teachers use the questions released by Ministry of National Education (MoNE) monthly and they evaluate the quality of these questions as suitable. Teachers evaluate the mathematics textbooks served out by MoNE as insufficient in terms of the quantity of involving these questions. In addition, some criticism appeared about the quality of the questions involved in the supplementary resources released by private publishers. The study also revealed that most of the teachers need a professional development course about the skill-based questions such as writing quality questions and developing their problem solving skills. The usage of PISA-like, skill-based questions in high-stakes testing (e.g., high school entrance examination) have been affecting teachers’ in-class practices, yet it is difficult to say that this effect is on the true way.