The group $SL_2(\mathbb{F}_q)$ acts on the projective line $\mathbb{P}^1(\mathbb{F}_q)$ (faithfully if $q$ is a power of 2, otherwise with kernel $\{\pm I\}$). We say this action is alternating if the corresponding map to $S_{q+1}$ actually lands in $A_{q+1}$.
For what values of $q$ is the action alternating? (It's easy to show by hand that it's not alternating for $q=2$ and that it is for $q=3, 4, 5$. I've checked it for a smattering of other small powers of $2$ and small primes by computer, and the answer appears to be for all $q \neq 2$, although it's possible I've made a coding error as ChatGPT gives a different answer (but with a bogus proof).)
You are right, the action is alternating for all $q>2$.
For $q>2$, $SL_2(\mathbb{F}_q)$ is generated by an element of order $3$ (an odd order permutation must be even) and elements of the form $\mathrm{diag}(a,a^{-1})$. The latter fix the element $1:0$ and act on the elements $b:1$ as $b:1\mapsto a^2b:1$, which is the permutation induced by the mapping $b:1\mapsto ab:1$ applied twice, and so is an even permutation too.