From what has been seen, Tsunade is the fifth Hokage. After the serious fight with Orochimaru and Kabuto, the medical ninja left with Jiraiya (a fellow Sannin) and Naruto back to the Hidden Village in the Leaves. Naruto has made several points where her mind set was similar to Sarutobi Sandaime, The Third Hokage. He accepts her as the Hokage, although she has serious problems that conflict with her moral duties (having debts due to gambling in other villages.) yes she is, and since becoming Hokage, Tsunade has primarily acted as a source of assignments and mobilizes Konoha's forces when necessary. in addition, Tsunade plays a large role in healing the more severe injuries that befall upon ninja she sends on missions. however, during Part II, her decisions begin to conflict with the views of Konoha's elders, and she is forced to form compromises before her plans can proceed. at the end of Part I, Sakura becomes Tsunade's apprentice, and over the time skip, Tsunade teaches her how to use her healing abilities and how to focus chakra and release it at a precise point so it will enable her to have superhuman strength. despite being needed for the role of Hokage, Tsunade has stated that she would leave Konoha if Jiraiya ever needed her help fighting Akatsuki.
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She becomes the fifth hokage.
She has called Tsunade: Tsunade-sama (Lady Tsunade), Hokage-sama, Godaime Hokage-sama (5th Hokage), and Shishou. (master)
because technically she is kined to Naruto because Mito Uzumaki is Tsunade's grandmother
Tsunade wakes up in episode 219 just when Kakashi Hatake is about to become the sixth hokage.
=No, but naruto calls her grandma tsunade just to annoy her.=