You got suggestions for both PHP library packages (PHP code) and PHP extensions (C code).
You should only install the PHP libraries if you know you want to use them. The suggestion feature of Composer allows any developer of a package to let Composer announce on update that there might be more software that enhances the library, but is entirely optional. The description next to the package name might have details on why the package could be installed. For example, a library for FTP and HTTP access might want to use existing FTP or HTTP clients, and will announce both as suggestions. If you decide you don't need FTP access, you only require the HTTP client to be used.
You cannot install PHP extensions via Composer. Installing them usually requires some kind of administrator access to the server, and depends on which OS is installed and whether or not it allows to install these extensions as a regular software package, or needs to have the PECL install toolchain available. If a PHP library suggests a PHP extension, then this extension also is completely optional, and you probably will know that if you need that feature (like access to MongoDB), you need the PHP extension as a prerequisite, but are likely to already have it installed (which would skip this suggestion from the list because it is fulfilled).