It depends a lot on the situation. The sender is the object that sent the action message, so you can do anything with that object that you could do in any other context. There's nothing special about the parameter.
For one example, you might do [someTextField takeIntegerValueFrom:sender]
to have a text field that shows the value of a slider bar.
If the sender offers some way to tell which button was pressed, then you could do that. I don't know of any class that does that, though. It would be a kind of awkward design. If different clicks are supposed to do different things, it would be better for them to have different action methods.