From the elected parliament to the state government.
Voters elect the members of the Landtag. Under Article 42, the Landtag normally elects the head of government by secret ballot, without debate and with a majority of its members. The state election is therefore not a direct popular election of the Minister President.
The Minister President appoints and dismisses ministers and sets the government’s policy guidelines. Within that framework, ministers run their own departments independently. The head of government therefore does not personally make every administrative decision.

The other three answers
The other titles do not fit here.
First Minister
First Minister is not the title used for Mecklenburg-Vorpommern’s head of government.
Prime Minister
Premierminister is not the title required by the German catalogue. English texts may render Ministerpräsident loosely as premier or prime minister, but this test uses the fixed answer Minister President.
Mayor
Mayor is a municipal office. The government of the whole state of Mecklenburg-Vorpommern is led by a Minister President.
The head of government does not chair parliament.
The President of the Landtag chairs parliamentary proceedings. The Minister President heads the state government instead. Both titles contain President, but describe different duties and institutions.
Article 42 also provides a special procedure if the election initially fails. If the prescribed periods pass and parliament does not decide to end its term early, a further ballot is held in which the candidate with the most votes wins. The majority rule for the normal initial procedure therefore has an exception.
Articles 41–43 and 46 · Constitution of Mecklenburg-Vorpommern ↗M-V: the Minister President heads the state government.
The Landtag elects the government’s head; the Landtag’s President chairs parliament.
Three words for this question
- die Regierungsspitzehead of government
- The person at the head of the state government.
- die Richtlinienpolicy guidelines
- The basic political direction followed by the government.
- ernennenappoint
- Formally place a person in an office.
